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Teenager Casts Light on a Shadowy Game
By KIRK JOHNSON
GERONIMO, Tex. — Levi Draher, 16, walked to the front of the Navarro High School gym in early March and picked up the microphone before a hushed audience of fellow teenagers.
“I died and came back,” he said.
Levi was found by his mother last Oct. 28, clinically dead, suspended on a rope he had slung across a bunk-bed frame. He had pushed his neck onto the rope, he told the rapt audience, aiming to achieve a surging rush as his brain was starved and then replenished with blood just before the point of unconsciousness.
The rush is the appeal of the choking game — or space cowboy or cloud nine or any of a dozen other names. In most schools and families it remains a subject of deep shadow and denial, students, parents and health professionals say.
“I did it because it felt good and I didn’t think I’d get caught,” said Levi, a slow-talking, sardonic skateboarder and hockey player from San Antonio. “Do I consider myself a miracle?” asked Levi, who told the students he had played the game three times before his accident. “Yes, I do.”
What happened that October afternoon was that Levi passed out faster than he could react and suffered a heart attack, said his mother, Carrie. His brain was deprived of oxygen for more than three minutes.
Levi’s survival and recovery against the odds — three days in a coma followed by a regimen of antiseizure drugs that he still takes — have made him perhaps the first scared-straight, been-there-and-back spokesman against the choking game. And there is a growing audience for his message.
While asphyxiation games have been around for many years, a series of locally publicized deaths around the country over the last few years, coupled with a realization that teenagers are seeing the game on Internet sites like YouTube, and playing it in more threatening variations — more often, like Levi, alone with a rope — are sparking a vigorous and open discussion in schools and among parents’ groups, summer camp administrators and doctors.
“We ought not to be timid in addressing this, and there has been timidity in the past,” said Stephen Wallace, a psychologist and chief executive of Students Against Destructive Decisions, a nonprofit group based in Marlborough, Mass.
A group called the Dylan Blake Foundation, founded by a parent who lost an 11-year-old son in 2005, said there were at least 40 deaths and 5 serious injuries from the game in the United States alone last year.
But the exact number remains uncertain because there has been little real research, health professionals say, and because medical examiners have been quick in the past to rule suicide. Some adults might also dismiss the game as the slumber party goof it was in years past, when constriction to the point of death was virtually unheard of.
But attitudes are shifting. Some medical examiners and pediatricians are looking at the increased teenage suicide rate from suffocation over the last decade and questioning whether dozens of deaths listed as suicide might in fact have been accidental, the result of a choking game experience gone wrong.
In 2004, according to the most recent figures from the federal Centers for Disease Control and Prevention, 779 children between ages 10 and 19 committed suicide by suffocation, up from 400 to 450 per year from the early 1980s through the mid-1990s, when the numbers began to rise.
Suffocation, which includes hanging, overtook gunshot in 1997 as the No. 1 way 10- to 19- year olds take their own lives, according to the centers.
Greater awareness in the medical community is in turn leading to the first serious scientific research about the game’s prevalence. Dr. Mark Lapore, an assistant professor of counseling psychology at Chatham College in Pittsburgh, is working on a survey in the Pittsburgh public schools. The American Camp Association, which certifies summer camps, discussed the choking game at its annual meeting last year.
“Asphyxiation games have been with us for generations, but what makes the current generation’s execution of this game different is that more kids are willing to play it alone,” said Dr. Thomas Andrew, the chief medical examiner in New Hampshire, who has consulted on 20 cases around the country where the game was suspected.
Of those 20 cases, most of which were listed officially as suicide, Dr. Andrew said he became convinced that four were really accidental from the choking game, and two others were unclear enough that they should have been changed to an undetermined cause of death. But he said that none of the death certificates, to his knowledge, were changed.
Anxiety about sex is another entanglement in the discussion. In some older teenagers and adults, the game can become associated with autoerotic practices of masturbation or intercourse to intensify orgasms, though Dr. Andrew and other experts say they think sex is not a factor for younger teenagers — and there was also no sex or ejaculation in Levi’s case, his mother said.
For now, most of the new debate is driven by advocates like Scott S. Metheny, an intense police officer from Upper Moreland, Pa., a suburb of Philadelphia, who has done more than 140 antichoking game presentations in the past 18 months on his own time.
He flew to Texas to talk to the students at Navarro, about 40 miles northeast of San Antonio, and to introduce Levi.
“Bringing Levi in was a shock factor,” Kandi Knippa, 18, president of the Drug Awareness Council, a student group. “It was very intense. But if we can save one life, it was worth it.”
About three-quarters of Ms. Knippa’s classmates, girls as well as boys, raised their hands when asked if they had heard of the choking game, which Mr. Metheny said was typical.
But the new debate also coincides with a reassessment of how teenagers think about risk. Conventional wisdom said adolescents often flirted with the edges of danger because they felt invulnerable.
Newer studies have dismissed that notion. They say that most teenagers are quite cooled-headed in assessing risk and reward — and that is what sometimes gets them in trouble. Adults, by contrast, are more likely to rely on experience or gut feelings than rational calculation.
Asked whether it would ever make sense to play Russian roulette for a million dollars, for example, most adults immediately say no, said Valerie F. Reyna, a professor of human development and psychology at Cornell University.
But when Professor Reyna asks teenagers the same question in intervention sessions to teach smarter risk-taking behavior, they often stop to calculate or debate, she said — what exactly would the odds be of getting the chamber with the bullet?
“I use the example to try to get them to see that thinking rationally like that doesn’t always lead to rational choices,” she said.
Those findings are influencing the way the choking game is discussed.
One doctor in Canada, Andrew J. Macnab, who is working on a major survey of the choking game in American and Canadian schools, said, “The best way is to get teens to talk to teens.” Dr. Macnab, a professor of pediatrics at the University of British Columbia, added that whoever talked about the game should use visual, concrete imagery.
Mentioning specific, narrow risks from the game, he said, like brain damage, medication and physical disfigurement can be even more powerful disincentives to adolescents than the idea of dying, which can seem theoretical or abstract.
“It’s not going to work if adults just say it’s a bad idea,” he said. “That tends to make it all the more attractive.”
In the Draher family, the question is how to use the gift of life snatched from the abyss. Mrs. Draher said she had never heard of the game before the day she found her son. Now she has joined a national group called Games Adolescents Shouldn’t Play (www.gaspinfo.com), which includes information about the game and Mr. Metheny’s PowerPoint presentation..
Levi’s father, Steven, said he was worried for a while that Mrs. Draher was going too fast in her newfound zeal.
“I was really kind of against her going public with all this — I thought she was pushing Levi into the limelight before he was healed,” Mr. Draher said in an interview in the family’s apartment in San Antonio. “But I’ve changed my mind. It seems to be helping Levi deal with it himself and talk about it, and that’s what matters.”
Levi, who has vowed to his parents never to play the game again, was fielding text messages on the couch as his father spoke. Mr. Draher said his son had moved on these days to other interests — girls and cars.
“He’s smelling perfume and gasoline,” Mr. Draher said with a smile.

Copyright 2007 The New York Times Company

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FEATURED ISSUE
Death and Grief

When coping with a death, you may go through all kinds of emotions. You may be sad, worried, or scared. You might be shocked, unprepared, or confused. You might be feeling angry, cheated, relieved, guilty, exhausted, or just plain empty. Your emotions might be stronger or deeper than usual or mixed together in ways you've never experienced before.

Some people find they have trouble concentrating, studying, sleeping, or eating when they're coping with a death. Others lose interest in activities they used to enjoy. Some people lose themselves in playing computer games or eat or drink to excess. And some people feel numb, as if nothing has happened.

All of these are normal ways to react to a death.

What Is Grief?
When we have emotional, physical, and spiritual reactions in response to a death or loss, it's known as grief or grieving. People who are grieving might:

feel strong emotions, such as sadness and anger
have physical reactions, such as not sleeping or even waves of nausea
have spiritual reactions to a death — for example, some people find themselves questioning their beliefs and feeling disappointed in their religion while others find that they feel more strongly than ever about their faith


The grieving process takes time and healing usually happens gradually. The intensity of grief may be related to how sudden or predictable the loss was and how you felt about the person who died.

Some people write about grief happening in stages, but usually it feels more like "waves" or cycles of grief that come and go depending on what you are doing and if there are triggers for remembering the person who has died.

If you've lost someone in your immediate family, such as a parent, brother, or sister, you may feel cheated out of time you wanted to have with that person. It can also feel hard to express your own grief when other family members are grieving, too.

Some people may hold back their own grief or avoid talking about the person who died because they worry that it may make a parent or other family member sad. It's also natural to feel some guilt over a past argument or a difficult relationship with the person who died.

We don't always grieve over the death of another person. The death of a beloved pet can trigger strong feelings of grief. People may be surprised by how painful this loss can be. But the loving bonds we share with pets are real, and so are the feelings of loss and grief when they die.

All of these feelings and reactions are OK — but what can people do to get through them? How long does grief last? Will things ever get back to normal? And how will you go on without the person who has died?

Coping With Grief
Just as people feel grief in many different ways, they handle it differently, too.

Some people reach out for support from others and find comfort in good memories. Others become very busy to take their minds off the loss. Some people become depressed and withdraw from their peers or go out of the way to avoid the places or situations that remind them of the person who has died.

For some people, it can help to talk about the loss with others. Some do this naturally and easily with friends and family, while others talk to a professional therapist.

Some people may not feel like talking about it much at all because it's hard to find the words to express such deep and personal emotion or they wonder whether talking will make them feel the hurt more. This is fine, as long you find other ways to deal with your pain.

People sometimes deal with their sorrow by engaging in dangerous or self-destructive activities. Doing things like drinking, drugs, or cutting yourself to escape from the reality of a loss may seem to numb the pain, but the feeling is only temporary. This isn't really dealing with the pain, only masking it, which makes all those feelings build up inside and only prolongs the grief.

If your pain just seems to get worse, or if you feel like hurting yourself or have suicidal thoughts, tell someone you trust about how you feel.

What to Expect
It may feel like it might be impossible to recover after losing someone you love. But grief does get gradually better and become less intense as time goes by. To help get through the pain, it can help to know some of the things you might expect during the grieving process.

The first few days after someone dies can be intense, with people expressing strong emotions, perhaps crying, comforting each other, and gathering to express their support and condolences to the ones most affected by the loss. It is common to feel as if you are "going crazy" and feel extremes of anxiety, panic, sadness, and helplessness. Some people describe feeling "unreal," as if they're looking at the world from a faraway place. Others feel moody, irritable, and resentful.

Family and friends often participate in rituals that may be part of their religious, cultural, community, or family traditions, such as memorial services, wakes, or funerals. These activities can help people get through the first days after a death and honor the person who died. People might spend time together talking and sharing memories about their loved one. This may continue for days or weeks following the loss as friends and family bring food, send cards, or stop by to visit.

Many times, people show their emotions during this time. But sometimes a person can be so shocked or overwhelmed by the death that he or she doesn't show any emotion right away — even though the loss is very hard. And it's not uncommon to see people smiling and talking with others at a funeral, as if something sad had not happened. But being among other mourners can be a comfort, reminding us that some things will stay the same.

Sometimes, when the rituals associated with grieving end, people might feel like they should be "over it" because everything seems to have gone back to normal. When those who are grieving first go back to their normal activities, it might be hard to put their hearts into everyday things. Many people go back to doing regular things after a few days or a week. But although they may not talk about their loss as much, the grieving process continues.

It's natural to continue to have feelings and questions for a while after someone dies. It's also natural to begin to feel somewhat better. A lot depends on how your loss affects your life. It's OK to feel grief for days, weeks, or even longer, depending on how close you were to the person who died.

No matter how you choose to grieve, there's no one right way to do it. The grieving process is a gradual one that lasts longer for some people than others. There may be times when you worry that you'll never enjoy life the same way again, but this is a natural reaction after a loss.

Caring for Yourself
The loss of someone close to you can be stressful. It can help you to cope if you take care of yourself in certain small but important ways. Here are some that might help:

Remember that grief is a normal emotion. Know that you can (and will) heal over time.
Participate in rituals. Memorial services, funerals, and other traditions help people get through the first few days and honor the person who died.
Be with others. Even informal gatherings of family and friends bring a sense of support and help people not to feel so isolated in the first days and weeks of their grief.
Talk about it when you can. Some people find it helpful to tell the story of their loss or talk about their feelings. Sometimes a person doesn't feel like talking, and that's OK, too. No one should feel pressured to talk.
Express yourself. Even if you don't feel like talking, find ways to express your emotions and thoughts. Start writing in a journal about the memories you have of the person you lost and how you're feeling since the loss. Or write a song, poem, or tribute about your loved one. You can do this privately or share it with others.
Exercise. Exercise can help your mood. It may be hard to get motivated, so modify your usual routine if you need to.
Eat right. You may feel like skipping meals or you may not feel hungry, but your body still needs nutritious foods.
Join a support group. If you think you may be interested in attending a support group, ask an adult or school counselor about how to become involved. The thing to remember is that you don't have to be alone with your feelings or your pain.
Let your emotions be expressed and released. Don't stop yourself from having a good cry if you feel one coming on. Don't worry if listening to particular songs or doing other activities is painful because it brings back memories of the person that you lost; this is common. After a while, it becomes less painful.
Create a memorial or tribute. Plant a tree or garden, or memorialize the person in some fitting way, such as running in a charity run or walk (a breast cancer race, for example) in honor of the lost loved one.
Getting Help for Intense Grief
If your grief isn't letting up for a while after the death of your loved one, you may want to reach out for help. If grief has turned into depression, it's very important to tell someone.

How do you know if your grief has been going on too long? Here are some signs:

You've been grieving for 4 months or more and you aren't feeling any better.
You feel depressed.
Your grief is so intense that you feel you can't go on with your normal activities.
Your grief is affecting your ability to concentrate, sleep, eat, or socialize as you normally do.
You feel you can't go on living after the loss or you think about suicide, dying, or hurting yourself.
It's natural for loss to cause people to think about death to some degree. But if a loss has caused you to think about suicide or hurting yourself in some way, or if you feel that you can't go on living, it's important that you tell someone right away.

Counseling with a professional therapist can help because it allows you to talk about your loss and express strong feelings. Many counselors specialize in working with teens who are struggling with loss and depression. If you'd like to talk to a therapist and you're not sure where to begin, ask an adult or school counselor. Your doctor may also be able to recommend someone.

Will I Ever Get Over This?
Well-meaning friends and family might tell a grieving person they need to "move on" after a loss. Unfortunately, that type of advice can sometimes make people hesitate to talk about their loss, or make people think they're grieving wrong or too long, or that they're not normal. It can help to remember that the grieving process is very personal and individual — there's no right or wrong way to grieve. We all take our own time to heal.

It's important for grieving people to not drop out of life, though. If you don't like the idea of moving on, maybe the idea of "keeping on" seems like a better fit. Sometimes it helps to remind yourself to just keep on doing the best you can for now. If you feel sad, let yourself have your feelings and try not to run away from your emotions. But also keep on doing things you normally would such as being with friends, caring for your pet, working out, or doing your schoolwork.

Going forward and healing from grief doesn't mean forgetting about the person you lost. Getting back to enjoying your life doesn't mean you no longer miss the person. And how long it takes until you start to feel better isn't a measure of how much you loved the person. With time, the loving support of family and friends, and your own positive actions, you can find ways to cope with even the deepest loss.