My brother’s life, unraveled

Anthony was a star. But he faced a threat that none of us could contain

Topics: Real Families, Life stories, Suicide, depression, Mental health, Mental Illness, Editor's Picks,

My brother's life, unraveled (Credit: Freya Zaheer)

My brother, Anthony, killed himself on a cool Thursday afternoon in April, a few weeks before his medical school graduation. He was 26.

He was staying with our parents in the New York suburbs. On his laptop, he read the New York Times and flipped through our sister’s vacation photos. He corresponded with a mentor and asked potential landlords about on-street parking during his upcoming residency. On Wikipedia, he read about Baal Shem Tov, an 18th century Jewish mystic who our father says is our ancestor, and the pop-punk band Rancid, which rocked his adolescence. He searched for suicide notes and sites on famous last words and asked Google, “How many times does a human heart beat in a life?”

Anthony had a longtime fixation on losing his hair. In chat rooms he visited, balding men vented and swapped treatment tips. Anthony researched the effects of antidepressants and antidepressant withdrawal on hair loss. He read pages on Prince William – did balding “hasten his engagement?”—and a site called Baldcelebrity.com. Anthony was not noticeably balding.

Two weeks before he died, Anthony tried to procure [a toxic chemical] from dealers in Asia. They told him it was only available in industrial quantities. When a representative at a scientific supply company in Ohio asked about his order, he concocted an elaborate lie about using it to clean precious metals:

“All work with this chemical is done under a recirculating chemical fume hood at a solution concentration of 1 g/L…[using] this solution, I use a face shield and PVC gloves to protect myself from inadvertent contamination or spills. Release of HCN from this solution is prevented by the alkaline pH of the solution.”

The rep accepted his explanation but when the order didn’t ship as soon as Anthony had hoped he wrote again to see what was taking so long. His package arrived a few days later.

On April 7, 2011, Anthony went for a run and then joined my father, Edward, and sister, Anna, while they ate lunch. They talked about “Anna Karenina,” which Anthony was reading, and Ukraine, where Anna and her husband had just vacationed. Anthony was acting erratic, Anna said, getting up several times and returning with piles of papers. After lunch he went outside. “He was doing leaps on the lawn,” my mother said. “I mean, a type of activity that I’ve never seen him do. Just balletic. Just leaping up into the air very gracefully.”

“He’s feeling lighthearted again,” she thought. “Things are going to be fine. It’s been a really rough winter.”

Anthony was in medical school at the University of Pennsylvania in Philadelphia and he had plans to drive down and see a string quartet that evening with his girlfriend. As the afternoon advanced, Anthony kept changing his mind about whether to go. Eventually he took some sandwiches our mother prepared and abruptly drove off. Our father stayed around the house and Anna and my mother headed separately into Manhattan. Sometime that afternoon, Anthony texted his date, “In jersey but there’s a lot of traffic” and then “Really not moving :(. Will keep you posted.” He returned home and climbed upstairs to a flat section of the roof.

Standing in the gray spring light, he photographed himself with his phone. He’s wearing a sweater over a sky blue oxford shirt. One picture frames him in a lower corner gripping his hair, looking up at the camera. He’s wearing thin-framed glasses and a few days’ worth of beard. He is handsome; the picture could be a fashion ad. In another shot, he stares directly at the camera, head tilted slightly, lips closed.

After Anthony took the poison, my father heard a thump from downstairs and found Anthony in spasms on the roof next to a volume of Shakespeare and a pack of Gauloises cigarettes. He didn’t leave a note.

Anthony and Anna, Courtesy of Jordan Bronstein

Suicide is an inexplicable act that forces survivors to seek an explanation. For someone as gifted and lucky as Anthony, the initial impulse is to think the reason must be equal to his violence, to the pain he caused. In the two years since he died, however, no terrible secret or disgrace has surfaced. Anthony’s story is subtler and more frightening and it doesn’t feel like an answer.

We worried about Anthony, especially in his final year, but his behavior was like so many other high-achieving Americans: He ate too healthily, exercised too much, studied too hard. He could be vain, but elites often are. Behind his veneer of well-being, he cannonballed through as robust a safety net as anyone with a mental illness could reasonably have, including two psychiatrists in his immediate family. In the emails and instant messages I clicked through after his death, he occasionally acknowledged his despair, but in life he mostly passed for a pampered and high-strung striver at a crucial moment in his career.

In elementary school Anthony was popular and stood out as a soccer player. On Friday afternoons he came home to do his homework so he could enjoy himself all weekend. After going to an academic camp in middle school, he began giving himself an education. “He did things oftentimes in a very deliberate way,” Anna recalled. Anthony would “be aware that this was an author he needed to read” like Dostoevsky, and then read the novelist because the kind of person he wanted to be would have read him. He was always comfortable asking questions about what he was learning, whether that meant talking medicine with my father’s oncologist friend or quizzing our Guatemalan housekeeper on technicalities in Spanish grammar.

He grew enamored with Thoreau in high school and one weekend sophomore year he took the train to Boston. We don’t know if he reached Walden Pond but more than a decade later both my sister and father remembered the trip as an attempt to run away. “I was both really excited for him and really didn’t understand what he was doing, or what he wanted,” Anna said. “I think he spent the train ride dodging the conductor and sitting in the bathroom so he wouldn’t have to buy a ticket.”

“For 10 minutes we said, ‘Well maybe it’s some psychiatric issue,’” my father, who is a psychiatrist, said. “And in retrospect it doesn’t seem like [the trip] was wrong, but it was sort of peculiar. You don’t know what was going on.” As in several later episodes, the Thoreau excursion feels less like independent mindedness than failed rebellion.

In school, “He did everything exactly how it should be done or you fantasize it should be done,” my father said. Even as he excelled, Anthony’s good looks and athleticism freed him from the social death of being a smart kid in high school. “He was very handsome, [he had] a lot of girlfriends, and he was invited to do everything,” my mother said. ”He really was a star. You just felt better when you were around him … If you were his friend, you felt as you’ve elevated yourself in a way, and I think that was the draw, but he wasn’t a snob. I don’t think he had a great sense of humor, but he appreciated people who did. He himself was not lighthearted, he wasn’t jovial and spontaneous, I don’t think, but I think he liked to be around people who were.”

I knew so little of this before Anthony died. I was five years older and left for boarding school when he was 9. We never lived in the same place again or spoke with any regularity. We caught up during school vacations and exchanged terse emails about hanging out more, but neither of us made it a priority. We’d always have adulthood to know each other.

From afar I heard news of Anthony’s emergence as an academic superstar. And like an imperial power amused by an upstart colony, I couldn’t believe that my little brother, whom I remember coming downstairs grumpy in blue pajamas, was so impressive. “He was a perfectionist. Ninety-five, to him, was a failing grade,” my mother said. “He was also very generous with his knowledge. He helped people a lot, in school … He wanted everyone to succeed.”

Anna remembers the kind letters he sent her when they were at summer camp, signed, “love, your bro.” Yet he could be blind to others’ needs, thinking nothing, for example, of asking her to drive him back to college, rather than taking the bus, so he could keep his study schedule and save some money. She drove two hours out of her way to do it, because she’s uncommonly kind and she loved his company. “He never felt like he was in a rush with other people. If he was with you, he felt very present. If he was speaking to you, it felt like he was focused on you. He wasn’t multitasking.”

Anna, who’s now a resident in psychiatry in Manhattan, said, “His selfishness served him well academically but became exacerbated by his disease. He couldn’t have empathy for himself, or for others. He couldn’t think of the effect that his death would have on all of us. He lost the capacity to see an honest reflection of himself and in turn lost the capacity to be able to think about how much we loved him, wanted to help him and would be devastated by his death.” She allowed that, “Maybe he wanted to hurt us in this way but that is both very hard and very painful to believe. His illness was very powerful and challenged who he was.”

After his junior year of high school, Anthony fled the suburbs for an international school in northeast Italy, near Trieste. “This year abroad would set my life on a new trajectory,” he wrote later in a 100-plus-page work of autobiographical writing, titled “Yuppie Love.” This composition, which he continued to revise during medical school, is spiked with a lacerating contempt for himself and other privileged people — “yuppies” — who can’t escape convention, an attitude that was rarely apparent in his public persona. Going to Italy, he wrote, “was a step ladder leading me out of this pool of shit, and I’d be a fool not to use it. This, I promised myself.” In the piece, Anthony described his year abroad:

Perhaps it was too exciting, too wonderful. Ten years after being in Italy, I feel cheated, lied to. Italy, the Adriatic sea, the teachers of the United World College, the strangers we met in bars and trains, everyone told us that life was beautiful and fascinating, that anything was possible, that goodwill and understanding and interesting, impassioned conversations periodically pregnated with long silences and deep eye contact could bring any two people together … Yes, Italy was good, too good in fact, and my life now is too bad, and it is the difference that is too much for me to bear.

In medical school Anthony asked for my thoughts on this manuscript and I didn’t read it. If I’d bothered I might have discovered a segment in which his friends in Italy discuss suicide in a smoke-infused dialogue thick with mentions of Camus and Nietzsche. At one point, Anthony calls suicide a “pretty viable option” for “Hemingway, Van Gogh, Kurt Cobain” and on the next page reveals his previous thoughts of suicide: “I wanted to scratch this itch with a knife.” One of this work’s two epigraphs comes from Chekhov: “I find it somehow sad and shameful to admit, even to myself, that my youth has passed entirely without love.”

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Anthony applied to college from Italy and scheduled his Harvard interview in Milan, a few hours from his school. When he arrived for the appointment, my father said the interviewer “acted like he didn’t even know an interview was scheduled.” Anthony felt like he had wasted his time. For whatever reason, he didn’t get in to Harvard.

“I remember thinking that it was actually really great,” Anna said when we spoke recently in her Upper East Side apartment. We were sitting at a table passing her baby, Natan, back and forth as he babbled and grabbed. “I thought it was important to have some kind of disappointment in life.”

Anthony returned from Italy the day of his senior prom. There’s a picture of him getting dressed that evening in black pants and a tuxedo shirt, his mouth a stern little line, hands posed on his stomach, elbows out like a dancer, haughty as a Russian princeling. In Italy, “He met people who were more matched for him, who he could relate to on an intellectual level,” his high school friend Jordan Bronstein said. He also “realized that he had a pretty good life.” A few days after prom, Anthony graduated as valedictorian of New Rochelle High School.

If Harvard’s rejection upset Anthony – my folks disagree — he showed the resiliency you’d hope to see after a minor setback. He went to Brown and his life of academic and social success continued amid the extracurricular delights of an Ivy League education. He played a young tough in “Romeo and Juliet,” made worldly friends, lived in a university Spanish-speaking house and worked as a medical technician in Spain one summer.

“He was really enamored by the Italian lifestyle,” his friend Andrew Matheny said. After dinner freshman year, Anthony liked to host coffee- and boxed wine-fueled salons, cafe culture-inspired happenings in his uninspiring dorm room. Afterward Anthony and Andrew often played chess. Later on they would go on double dates and on roads trips with their group of friends.

Freya Zaheer, who began dating Anthony junior year, remembered two sides to him. He was like an “amazing 19th century romantic literary hero” who read her “Venus and Adonis” and biked around Providence with her perched on the back. “It was so wonderful to spend time with him and when you didn’t get him you felt deprived.”

He was also “maniacal” about studying. “I don’t think he got a single question wrong on any organic chemistry test,” she said, He seemed similarly consumed by his desire to “perfect his own body.” He established a sacrosanct routine of drinking green tea, working out and taking a schvitz. “He had this incredible will,” she said. “Nothing was more important than his will.”

Majoring in biology and international relations, Anthony made Phi Beta Kappa as a junior. Without taking a year off, he started at the University of Pennsylvania’s medical school, which is consistently ranked among the top three in the country.

Anthony and Freya, Courtesy of Freya Zaheer

“There’s like a feeling of wanting to say the right thing, to convey who he was or what he meant to me. I don’t feel like I’m doing him justice in a certain way,” Anna, my sister, said. “I felt like he had a really good way of filtering what was important and what wasn’t. Except, at the end of his life, when he didn’t, because he obviously was sick.”

Anna hypothesizes that Anthony suffered from depression that metastasized into a “psychotic depression,” in which he lost his grasp on reality. The disease causes “changes in your concentration, changes in your motivation, changes in your sleeping habits” — Anthony never slept well — “and changes in your eating habits. But then it becomes that you have real cognitive changes where things that you would normally think are really a horrible, shitty idea, all of a sudden become normal.”

Aaron Paul, a friend of Anthony’s from college and medical school, said that when they lived together that first year in Philadelphia, the balance of Anthony’s college career evaporated. Paul, who is no slouch, said Anthony would study past midnight on a Friday, say, for an exam two or three weeks away, showing a “singular preoccupation with schoolwork that was clearly obsessive.” Their friendship suffered. Medical school “can be somewhat socially isolating,” Paul said. “I think we were all at times a little bit depressed.”

For Anthony’s second year, my mother said he wanted to “break all records.” He set himself apart further, renting a room from a Chinese immigrant family where he couldn’t have guests. Medicine offered Anthony an endless body of knowledge in which he could immerse himself but Anthony also apparently enjoyed the less cerebral aspects of the field. He emailed me that spring, “doing your first c-section on your b-day adds a warm and fuzzy component to this whole med school thing.”

I visited in the fall of his third year, a few weeks before President Obama was first elected, when Anthony was renting an attic room from an older woman. The thinly furnished space contained a bed, a desk, an electric kettle for green tea and the instant oatmeal he stockpiled. I don’t remember it, but he also must have had an assemblage of over-the-counter pills. “Vitamins, muscle this and heart that and bone,” my mother recalled his intake at the end of his life. “He was taking some Chinese pills over the counter that he got on Central Avenue for hair growth. He might have been taking up to 40 or 50 pills a day.”

At the end of his third year of medical school, Anthony accepted a Fogarty grant from the National Institutes of Health to conduct research for a year in South America. My mother thought he should graduate first but he pushed back, “No. You told me not to go to Italy with United World College and it was such a fantastic experience,” she remembers him saying. “And you were wrong.”

Anthony lived in Santa Cruz de la Sierra, a fast-growing agricultural business city in Bolivia. “It had nothing in it except about 4 million people,” my mother said.

Anthony, who spoke excellent Spanish, joined a soccer club and dated a Bolivian woman who was also training in medicine. (After Anthony died, there was a mass for him in Santa Cruz, my father said.) He studied Chagas disease, which is carried by an insect known as the kissing bug. Patients typically show mild symptoms for a few weeks, and then Chagas can lie dormant for years before returning as a potentially fatal cardiac or gastrointestinal condition. To set up appointments to examine patients and do research, “he needed a team, and they were lethargic … no one was responding with the urgency that he felt they should,” my mother said. ”He was desperate to get it done.”

Freya and Anthony had broken up but that year he told her, “I’m getting much worse in my old age, more stubborn, more difficult to be with.”

Anthony did about 150 eye examinations, “Then he suddenly felt he had to have more, as many as he could get,” my father, who told him to go relax for a week or two in Buenos Aires or Chile, said. Anthony stayed in Bolivia. One mentor remembers having to tell Anthony to stay in bed when he contracted dengue fever.

Despite his frustrations, Anthony’s research moved forward. Initially, the team thought that pupillary action in patients with Chagas would offer clues about the disease’s future course. Diabetes, a disease known to have effects on the pupil, was used as a positive control. The initial hypothesis failed, but the pupils did help explain complications related to diabetes. When Anthony came home he received another grant to support him to write an article for a medical journal. (His research is still likely to be published.) On top of school and applying to residency, the article “was the beginning of his unraveling, I think,” my mother said. “His serious unraveling.”

Anthony, Courtesy of Freya Zaheer

New Rochelle is a leafy New York suburb with a grandiose high school building, 30 minutes by train from Grand Central. Before Anthony was born, my parents moved into a white colonial there, bringing their arty tastes and two young children from the Upper East Side. Over three decades they’ve inhabited a cluttered home with paintings and exhibition posters on the walls, Turkish rugs on the floors and fridges stuffed with cheeses, smoked fish and pickled vegetables. The counters overflow with fruit. The hundreds of flowers my father plants every year edge the poorly tended lawn. I don’t understand why someone as disdainful of middle-class comforts as Anthony would have chosen to stay there.

Among our friends, the house is best known for its kitchen walls, which are covered with pictures of my siblings and me playing soccer, on family trips to California and Europe and starring in a preposterous number of graduations. On the large sunlit room we call the porch, which can host a Thanksgiving dinner for 25, there’s a jungle of houseplants, too many chairs, a wall of bookshelves hurting under art tomes and those no-frills paperbacks you can’t buy anymore.

After he returned from Bolivia, Anthony passed the summer working on the porch. He saw friends, took his pills and did his exercises. He constantly called a statistician who was supposed to collate data for him. He could have rented a place in the city but he’d always been a bit of a cheapskate. My parents liked having him around and they kept the house stocked with the foods he preferred – my mother doesn’t think she ever saw him eat a sweet. Living in New Rochelle he didn’t have to worry about doing his laundry or cleaning the house. In August he learned that he had made Alpha Omega Alpha, the medical school honors society. He’d be one of the top graduating medical students in the country.

Anthony’s academic schedule was loosely structured so he could meet his obligations in short trips to Philadelphia. By this point, most medical students are obsessed with “the match,” the process hospitals use to select graduating students for residencies. It is famously stressful, but every indication suggested that Anthony would be a strong applicant.

Anthony was leaning toward specializing in radiology, but he couldn’t get comfortable with the choice. “He was very excited about the idea that radiologists were actually the people making the diagnoses,” Anna said. “Yes, it’s the internist who’s the first person in the triage line, but it ultimately comes down to radiology, reading the scans and finding what’s going on, especially these days.”

Radiology is a prestigious, lucrative track. But Anthony may have also been attracted to the limited interactions radiologists have with patients. He was “uninterested in the amount of scut work that’s involved with other fields of medicine,” Anna said. Anthony wouldn’t have been the first doctor to bristle at filling out endless insurance forms, but he saw radiology as “a way around it. Which, in reality, it’s not … But that was a fantasy that he had.”

Anthony dissected his options with my parents and on long calls with Anna. In flailing notes to hospital officials, he changed his desired program, switched interview dates and asked to extend at least one deadline to accommodate his research. As the matching process advanced, between November and January, he considered pursuing pathology, a career of working with corpses and staring at slides. To my family, this seemed even more gnomic than radiology. They couldn’t fathom why he would even consider it.

Each of them would have preferred, and to some degree encouraged, him to consider a more patient-centric career in internal medicine. “I think you would get bored just reading films all day long,” my mother remembers telling him. “And he said, ‘Well, you know it’s really expanded.’ And I said, ‘Well, that’s fine whatever you want to do. You can always change.” Before beginning a radiology residency, young doctors usually do a year in general medical training. My family hoped it would inspire him to take a new path.

In January, Anthony traveled to Boston to interview at two Harvard hospitals, Massachusetts General and Brigham and Women’s. He appeared so anxious before the trip that my father wondered if he would survive.

After the first interview Anthony spoke to Anna. He was “unbelievably ruminative,” she said. “He could not understand why anyone would have him as a resident and couldn’t recall the interviews.” Worried about another sleepless night he considered blowing off his appointment at Massachusetts General, arguably the best hospital in the country. “It was so scary to him and he couldn’t articulate what was scary.” Anna was scared too, “And I thought that if I gave him enough love that he would be OK.”

When Anthony returned home he said to my mother, “I don’t know what the interviews were about.” One questioner had tossed him a softball about whether he had any questions about the program, and he didn’t. Weren’t all the programs basically the same? He felt wounded, my mother said, that “No one seemed to raise their eyebrows when he said he had had a Fogarty. That he was in Bolivia.” Never mind that his research wasn’t related to radiology. “He kept saying he’d wasted a year. Why did we let him go?”

Anthony had other preoccupations. He complained of nagging neck pain, the legacy of a high school rugby injury. “I think he just magnified it,” Anna said. “If it was so severe, he wouldn’t be able to run, and he was running every day for miles and miles.” His hair loss remained a concern. Sometimes he stood on his head, a crackpot remedy for improving blood flow and stimulating hair growth. In a January email, he complimented my hair and asked how I made it look so good. I didn’t do anything to it, I wrote back, and my hairline was five years more, um, distinguished than his. If I had better understood his condition I wouldn’t have asked if he’d considered shaving it.

The year in Bolivia still gnawed at him. In his original medical school class, he said, the radiology applicants were less competitive. If he hadn’t gone to Bolivia, he came to believe, he would have easily landed his first choice of residency. This was delusional; he was getting interviews at top hospitals.

Before his year abroad Anthony had taken a prescription remedy for male pattern baldness that can cause sexual side effects and depression. He brought a supply of the drug to South America, but for reasons that remain unclear he stopped taking it. After returning home, he resumed the medication but the fellowship, to his mind, accelerated his hair loss as well.

In a January email to Anna he displayed a measure of self-awareness, “peace and love and my endless thanks for bearing with me during my (hopefully) brief psychotic disorder.” She had sent him a list of psychiatrists and he said he would contact them. Nothing suggests that he did. My mother repeatedly asked him to reduce his pill intake. On the nights before his residency interviews, Anthony worked himself into sleepless fits. Before one interview in Manhattan he stayed at Anna’s apartment and insisted that she sleep on the couch so he could be more comfortable. Anna obliged him. In March, we reminded ourselves, he would match at a hospital and this unbearable period would be over.

It was not all as hellish as it sounds. Anthony could still pull himself together. At my December birthday party, at a Lower East Side bar, he charmed my friends in Italian. One sophisticated woman he’d been chatting with said to me, “Your brother is handsome.” The next month, at another party, he told me he was taking antidepressants and feeling better. I asked him why he was living in New Rochelle. If he didn’t have to be in Philadelphia, why didn’t he rent a place in Manhattan or Brooklyn? He insisted it wasn’t an option, that he knew what he was doing. Anthony’s friend Aaron Paul was there and mentioned he’d been studying gynecology, prompting Anthony to reply that he didn’t know anything about the subject. I took this as an invitation for some fraternal ribbing. Anthony didn’t find that funny at all.

Around February, I learned that Anthony was considering doing his intermediary year at a community hospital in New Rochelle and continuing to live with my parents. He reasoned that he needed a rest and decided, probably incorrectly, that there would be less pressure at a local hospital. Plus he’d still follow that with a radiology residency so it didn’t matter. My parents strenuously objected to his turning down a world-class hospital and realized that it wasn’t healthy for him to be at home anymore, but what could anyone do except wait for the match?

In late winter, med students across the country submit a ranked list of residency programs. In mid-March they learn if they matched and where. If Anthony ranked the New Rochelle hospital first, and they chose him, he’d be committed to it. Anna had labored over Anthony’s list with him and she was confident that he had led with a major teaching center.

At medical schools, Match Day is an understandably celebrated occasion and my mother asked Anthony if he’d be going to Philadelphia to be with his classmates. He said no. Since he barely knew the students he’d be graduating with, he could just find out online. “I thought that was a very bad sign,” she said.

And then he matched: A general year at Brigham & Women’s in Boston followed by NYU’s elite radiology program. He strutted on Facebook, “the brigham for prelim and then nyu for rads. all i want to know is who’s coming with me?”

This New Year’s Day my mother and I sat with bagels, lox and coffee at the ovular wooden porch table where Anthony had liked to work on his laptop. As she spoke, she stared at a spot in the middle of the table, one hand curled at her brow, the other pressed flat against her cheek.

“He got what he wanted and I congratulated him and he looked terrible,” she said. “I feel guilty to this day for not having said to him, ‘What’s wrong, why do you look so terrible? You just won the jackpot.’ I didn’t say it. To me it was such an obvious triumph of something he had been working for for six or eight months. All the work and the pain and the stress and the fatigue — it was all over and it was all resolved the way he wanted it. And he was just despondent. I never said anything and I’m in pain over that, always in pain over that to not ask the obvious. I almost was perhaps oblivious to the obvious because we had so many long arduous discussions about how he felt and how each interview went and how he couldn’t decide.

“But most important, he was singularly preoccupied by thinking he had failed himself. He became convinced he had made a mistake by accepting a Fogarty grant, and for that he could never, ever trust a decision he made again. That [the residency] decision came from an outside source. It had nothing to do with him and it wasn’t reliable, it wasn’t accurate. And therefore by extension he couldn’t trust himself to make important decisions. Perhaps he meant by that medical decisions for other people or medical conclusions based on data and research and examinations.”

In an instant message exchange, he told a friend that the result had left him feeling “dead inside.” As best I can tell, he started pursuing the poison six days later.

Anthony and Cuba, Courtesy of Freya Zaheer

According to the American Foundation for Suicide Prevention, at least 90 percent of people who kill themselves suffer from a treatable and diagnosable mental illness. Anthony didn’t see a psychiatrist and was never diagnosed, but he displayed symptoms of any number of them. These diseases can be triggered by genetic makeup, by experience, by a life situation, by family dynamics dating back to early childhood.

Not long after his death my mother asked me why Anthony couldn’t just muddle through like the rest of us, why he was so fragile. It’s the question all of us who loved Anthony have to live with, how such a capable person could be so wrong about the biggest question there is and so many smaller ones. His death is hard to understand and harder to forgive. It goes against the human instinct to make what use of our talents we can, to breed, to survive.

Anthony understood this too. His whole life prepared him for work that unfolds over decades. He treated his body similarly. (My mother, when she confronted him dead on the hospital gurney, remembers thinking that he looked like a “Greek god.”) “How could this kid be depressed when everything was working out?” Anna asked. Anthony must have wondered the same thing.

The grief and guilt my family feels linger. For me, they pull more strongly than the memories. Anthony’s friends are building families and careers. My parents’ suffering, in particular, has been unimaginable. But they cope and persevere. The April after Anthony died, Anna gave birth to their first grandchild. Anna and I push on, managing as we go. We are living things and it is in the struggle that we thrive.

Alex Halperin is news editor at Salon. You can follow him on Twitter @alexhalperin.

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