I can’t stop staring at her hair. It looks thinner at the scalp, and slightly discolored. Why are her lips so chapped? When she walked in, I noticed her thighs are so thin they don’t even touch. Her collar bones are poking out, too.

I give her a backstory: She went to an elite university; her parents put a lot of pressure on her growing up, and now she puts that pressure on herself, and when she feels out of control she compensates by being over controlling about what she eats because she has to be perfect, and being perfect means being smart and thin, and if she’s not pretty, smart, thin, perfect then it’s not worth her being alive. It’s my first three minutes meeting her and I’m already thinking about her suicide.

After starting medical school and learning a thing or two about Post-Traumatic Stress Disorder, or PTSD, I began to question whether this obsessiveness with strangers’ and friends’ mental health was akin to a symptom of PTSD. I realized I check some of the boxes – intrusive thoughts, avoiding things that might trigger certain memories, trouble sleeping at night, and hypervigilance. In the past, I had assumed hypervigilance means “high-alertness” to startles and loud noises. For me, if I hear the slightest ping of melancholy in someone’s voice, I am compelled to begin “therapizing” whomever it is I am talking to. I’m used to playing the therapist role within my friendships. But I feel what was an emotional connection has turned into obsession. Maybe it’s my futile way of trying to prevent the death of another close friend.

We think often of how families are torn apart because of these losses, but rarely do we hear how their high school friend group fails to fill the space of that person or how a distant acquaintance might have trouble going to the same coffee shop where they met that person. What kind of support do we extend to those more distally left behind? And how do we even know if we’re one of those distally impacted people?

A recent study, published in the Journal of Affective Disorders notes that, “suicide bereavement in young people often has distinct features, including feelings of stigma, maladaptive coping strategies (e.g. alcohol misuse), and traumatic guilt.” Studies such as these point to the need for other ways to identify and support young people who may have lost friends or classmates.

The need is urgent. Suicide among people ages 15-34 is one of the three leading causes of death and drug overdose-related mortality and it continues to rise in the United States, particularly worsened since the COVID-19 pandemic. It should be unsurprising then that myself and so many of my peers have either lost a loved one to suicide or substance-use, or personally struggle with suicidality and substance-use. Although we continue to gather epidemiologic data on the quantity of lives lost, we fail to capture the quality of life lost for those of us left behind.

At 19, my friend Grace lost her life to suicide after fighting anorexia nervosa for over a decade. I left work when I got the phone call that Grace hanged herself and I rushed to the hospital. She was on a ventilator and braindead, but I got to say my last goodbyes before they pulled the plug.

Two years later my best friend Claire died from a drug overdose.

I’m now 23 years old and recently learned I also dissociate. Our first week we had a lecture on addiction medicine and had to learn how to deliver naloxone intranasally. I remember physically going through the motions but placing my consciousness in the back of my brain. Dissociation is protective in that it separates your thoughts, sensations, and feelings from your physical self and environment. It allows your body to keep moving while you just watch yourself from the inside. It was my only choice — either put my consciousness in the back seat of my brain or have a panic attack in front of all my new classmates while thinking about how Claire died alone in her apartment with no one to administer naloxone when she needed it.

I write this piece not to have every person who has ever lost someone to try to diagnose themselves with PTSD. I write this piece to call attention to the fact my generation is experiencing a collective trauma on a national (arguably, international) scale that has already had, and will continue to have, significant consequences for our psycho-social and emotional development. The signs and symptoms of trauma may go unnoticed because they appear in inconspicuous ways – unexplained belly aches, irritability, intrusive thoughts, and so much more.

There is a desperate need for expanded access to mental health resources tailored to those struggling with suicide or substance use-related bereavement. This support needs to be publicized (so kids know where they can turn), affordable and accessible. I grapple with whether this is the responsibility of high schools and colleges or individuals. Whatever, we might start by:

  • Reaching out to those struggling with bereavement and connecting them to support groups
  • More openly discussing loss of loved ones and the impacts it has on our lives
  • Destigmatizing seeking mental health counseling

For me, I know I will continue to think about why that girl’s hair is so thin or why that guy drinks a little too much on the weekends, but the next time I sit down for coffee with a classmate, I’ll try to ask them how their day was without thinking about their psychopathology.

Matthew Ponticiello is a medical student Yale University.