Suicide is the third most common cause of death amongst adolescents between 15-24 years of age, and the sixth most common cause of death amongst 5-14 year olds. It is estimated that over half of all teens suffering from depression will attempt suicide at least once, and of those teens, roughly seven percent will succeed on the first try. Teenagers are especially vulnerable to the threat of suicide, because in addition to increased stress from school, work and peers, teens are also dealing with hormonal fluctuations that can complicate even the most normal situations. Because of these social and personal changes, teens are also at higher risk for depression, which can also increase feelings of despair and the desire to commit suicide. In fact, according to a study by the National Institute of Mental Health and Neuro-Sciences (NIMHANS), almost all people who commit suicide suffer from a diagnosable mental disorder like depression, anxiety, somatoform disorder, adjustment reactions or alcohol and drug abuse. Often, teens feel as though they have no other way out of their problems, and may not realize that suicidal thoughts and feelings can be treated. Unfortunately, due to the often dysfunctional relationship between teens and their parents, teens may not be as forthcoming about suicidal feelings as parents would hope. The good news is there are many signs parents can watch for, in their teen without necessarily needing their teen to open up to them. At some point in most teens lives, they will experience periods of sadness, worry and/or despair. While it is completely normal for a healthy person to have these types of responses to pain resulting from loss, dismissal, or disillusionment, those with serious (often undiagnosed) mental illnesses often experience much more drastic reactions. Many times these severe reactions will leave the teen in despair, and they may feel that there is no end in sight to their suffering. It is at this point that the teen may lose hope, and with the absence of hope comes more depression and the feeling that suicide is the only solution. It isn t. http://www.chrysalislife.org 1 Chrysalis Counseling, Bangalore, India
Many of us go through the ups and downs of life, sometimes getting disheartened, sometimes confused. Others face situations in life that become insurmountable, and then begin to question whether anything good will come out of it. What are the factors that lead to this question? Let us list out a few of them: One major setback whose intensity is more than what one can handle. Many small setbacks, each of which may not appear big, but their cumulative effect could be shattering. When a person is let down by those whom he trusts, leading to a general feeling that there is no one he can rely on. The loss of a loved one, a relationship, or a cause that meant a great deal to the person. The threat of being subjected to a situation which could become humiliating, distressing, or crippling. Loss of one s objective in life, without much hope of regaining it. Social isolation, and a feeling that one does not belong in this community. Onset of a mental illness that may not be identified or diagnosed. Among the teens, it has been found that factors leading to a sense of hopelessness could be: Failure in examination or setback in academics. Strong differences with parents or authority figures. Unhealthy or abusive relationships. Physical or mental disorders. Feelings of anger and guilt. Theoretical and Clinical Observation This section consists of four parts, all focussed on clarifying suicide in children and adolescents: definition, depression, specific precipitating events, and the family system. Definition Defining suicide is a complex endeavour. Pfeffer (1986) has provided the following definition: Suicidal behaviour in teens can be defined as self-destructive behaviour that has the intent to seriously damage oneself or cause death. http://www.chrysalislife.org 2 Chrysalis Counseling, Bangalore, India
Depression First and foremost, it must be understood that not all suicidal youth are depressed, and that not all depressed youth are suicidal. Depression and suicide are not equivalent. Yet, Pfeffer (1986) has noted that depression, distinguishes many suicidal children and adolescents from non-suicidal groups. Depression can be noted in mood and behaviour (ranging from feeling dejected and some hesitancy in social contacts, to difficult to contact, serious disturbance of appetite and sleep), verbal expression (ranging from talks about being disappointed, excluded, blamed, etc., to talks of suicide, abandoned, helpless). Behaviours such as excessive aggressiveness, sleep disturbance, change in school performance, decreased socialization, somatic complaints, loss of energy, unusual change in appetite and weight have all been associated with depression. It is important to remember, however, that depression does not equal suicide in a simple one to one fashion. Most people who commit suicide experience unbearable pain, but not necessarily depression. The unbearable emotion might be hostility, despair, shame, guilt, hopelessness or helplessness. What is critical is that the emotion-pain-is unbearable. Unendurable psychological pain is the common stimulus in suicide (Shneidman, 1985). Specific Environmental Precipitating Events A current formulation regarding suicide is that simply due to an external event; for example a rejection, loss of a loved one etc. Precipitating events such as deprivation of love, sexual abuse, death of a parent, divorce, rejection etc. do occur in suicides of adolescents. Shneidman (1985) has noted that the common consistency in suicide is not the precipitating event but life-long coping pattern.children and adolescents who kill themselves experience a steady toll of threat, stress, failure, challenge, and loss that gradually undermines their adjustment process. http://www.chrysalislife.org 3 Chrysalis Counseling, Bangalore, India
Suicidal Youth and their Families A review of the literature (e.g., Barry M and Wagner, March 1997, Psychological Bulletin, Vol 121(2), pages 246-298, Family Risk factors for Child and Adolescent Suicidal Behaviour) suggests that family dysfunction are risk factors for completed suicide or suicidal symptoms in childhood or adolescence. The family system is often inflexible, any change is seen as a threat to the survival if the family. Denial, secretiveness, and especially a lack of communication are seen in families. Long-term disorganization (malfunctioning) has been noted in these families, for example, mother or father absence, divorce, alcoholism, mental illness. Behavioural observations In understanding suicide in teens, we need to be aware of behaviours that are potentially predictive of suicide. The clues here are ones that are equally applicable to other age groups and not just teens (although the mode of expression may differ depending on age). Verbal Statements As with behaviour, the attitude toward individuals making verbal threats is too frequently negative. Statements are seen as just for attention. This attitude results in ignoring the behaviour of a person who is genuinely perturbed and potentially suicidal. Examples of verbal statements from young people are the following: I am going to kill myself or I want to die. Cognitive Clues The single most frequent state of mind of the suicidal person is constriction. There is a tunnel vision, a narrowing of the mind s eye. There is a narrowing of the range of perception or opinions or options that occur to the mind. Frequently, the person uses words like only, http://www.chrysalislife.org 4 Chrysalis Counseling, Bangalore, India
always, never, and forever. Examples of young people are the following: No one will ever love me. Only mom loved me ; Dad will always be that way. Emotional Clues The child or teenager who is suicidal is often highly perturbed; he or she is disturbed, anxious, perhaps agitated. Depression, as already noted, is frequently evident. Teenagers are often very angry and hostile; they may feel rejected and unsuccessful. A common emotional state in most suicidal teens is hopelessness-helplessness. The hopelessness goes something like this, Nothing will change. It will always be this way. The helplessness goes something like this, There is nothing I can do. Sudden Behavioural Changes Changes in behaviour are also suspect; individuals who suddenly become withdrawn and isolated may be at risk. Such changes are of particular concern when a precipitating painful event is apparent. Performance in school, such as sudden failure, may be an important clue. A sudden preoccupation with death, such as reading and talking about death, may be a clue. Prevention of youth suicide No one can take responsibility for another person s life. Do not put yourself in a rescuer s role, or try to take control of the suicidal person. At the same time, remember that it is possible to reach out very effectively and prevent many potential suicides if one follows certain simple guidelines. Prevention of suicide can be done at three levels: 1) Working with normal youngsters to ensure that they do not slide down emotionally when faced with setbacks. 2) Working with those who have suffered setbacks or problems that could possibly make them suicidal, or even those who have shown an actual intention of suicide. 3) Working with those who have attempted suicide and failed. Normal Youngsters http://www.chrysalislife.org 5 Chrysalis Counseling, Bangalore, India
With urban lifestyle becoming more and more competitive, youth are put under tremendous pressure at every stage of their life. There is pressure for academics, pressure on winning and retaining friends, and pressure for looking good and being well dressed. In this situation, it is easy for a person to feel isolated or helpless. Keeping communication channels open is one of the most important preventive measures. Be non-judgemental with the child, show total acceptance, and encourage him to talk, particularly about his feelings. A small judgemental remark like why do you get involved with such friends? or why do you keep doing this? can put off the person, and the communication channel can break. If he/she gets into the habit of bottling up his emotions, his chances of becoming suicidal at the time of crisis becomes much higher. Those who have suffered setbacks, or show suicidal intentions The crucial factors that will prevent the person from attempting suicide are: If he feels needed by at least one person. If he feels there is still some hope left that things will change for the better. This becomes more important for children and teenagers because often they feel that they are not needed by anyone in this world. If you come across someone who has suffered setbacks and is likely to feel suicidal (whether he has actually expressed such feelings to you or not), try to build up the above mentioned two factors of being needed, and developing hope. A few important steps can be put down in nutshell to help a person who is distressed and likely to go towards deliberate self-harm: Allow him/her to talk, cry out, release his/her emotions (but ensure privacy). Empathize with him by accepting that his problem is real and serious. Do not try to belittle his problem and make generalized statements like, Everything will be alright, don t worry. Try to keep him/her away from an atmosphere where they he/she is constantly reminded of his/her failure, guilt or setback. Help in the form of emotional support can be given to a suicidal person, from any source. It is obviously better if his nearest and dearest, or most loved ones give him their attention and affection. http://www.chrysalislife.org 6 Chrysalis Counseling, Bangalore, India
Those who have attempted suicide and failed Let us keep in mind the fact that a person, who has attempted suicide and failed, has probably not given up his desire to end his life. Listening plays an important role. One should open out communication channels and make him talk about himself, his aspirations and frustrations, his hopelessness or helplessness. If he feels comfortable sharing his feelings, his suicidal tendency will come down. It is very important for the caregivers not to label a person as a suicidee or look down upon him with pity. One should always keep in mind that the person who attempted suicide did so, when life became unbearable for him. The role of parents and elders Parents and the other elders who are guardians, can bring up a child with positivity, selfesteem, and the capacity to face setbacks in life. Such children will not become suicidal even when faced with major hurdles of life. Here are few tips that should be followed as far as possible at all times: Never compare your child with a sibling, cousin, classmate, or any other person. Motivate and encourage him. Do not undermine the self-esteem of your child by making derogatory remarks about him. Statements such as, Why are you born?, You will never achieve anything in life. Statements such as these can leave a permanent mark on the psyche of the child. Do not make him feel unloved, unwanted, and thus making him feel insecure. Do not value him based on his marks or success. http://www.chrysalislife.org 7 Chrysalis Counseling, Bangalore, India
Listen to your child- encourage him to talk on any topic without inhibition. Particularly make him talk about how he feels in different situations. Never ridicule or put him down when he says something wrong. Give him emotional support when he is facing anxious moments such as exam results. If the child or youth shows sudden withdrawn behaviour, keep an eye on him, and check out for any of the symptoms mentioned earlier. In conclusion Suicide and suicidal behaviour in children and adolescents does occur. We all need to increase our awareness and understanding. Be aware of yours/other s depression levels, particularly when one facing a setback. Keep your communication channels open with your family, friends and counsellor. Keep boosting your self-esteem by listing out what your strengths are. Maintaining such a positive attitude will help you and others tide off any crisis if it comes to you and will also help you to radiate positively to others who may be in distress. Bibliography Pfeffer (1986) ---need article reference-- Shneidman (1985) ---need article reference-- Barry M and Wagner, March 1997, Psychological Bulletin, Vol 121(2), pages 246-298, Family Risk factors for Child and Adolescent Suicidal Behaviour http://www.chrysalislife.org 8 Chrysalis Counseling, Bangalore, India