A teen at my son’s high school committed suicide this week. It is not the first time he and I have discussed the topic, but the first time since he was a teenager. This tender age with new truths inspired a new exploration of this crucial conversation. Unlike prior incarnations, the only way to engage this conversation in a relevant way was to be willing to hear about the times he has wished he was dead.
It is a painfully common experience for teens to wish they were dead. Not because their life is misery, but because they have big feelings, and haven’t learned how to regulate/contain and manage them. This isn’t necessarily active suicidal ideation. They don’t necessarily go into deep strategy about a plan, and don’t necessarily start to lay out and commit to a plan. What they more commonly experience is what we refer to as passive suicidal ideation, where they essentially wish they were dead, perhaps fantasize how people would respond if they were dead.
I am not suggesting passive suicidal ideation isn’t a concern. It is. It can most definitely be the step before active suicidality. But on its own, it is a rich source of information about how your teen thinks about themselves, their lives, and their options for handling the feelings and situations that burden them. This is the understanding we will need to help them develop skills and perspectives to combat the experience of suicidality.
There are three main features of suicidal ideation we need to explore with our teen. Trust me that I fully understand this is a terrifying conversation, and it will require the parent to have all their facilities fully resourced.
Suicide as Escape of the Moment
First and foremost, in most cases, the wish to die is the wish to escape. The wish is to escape a circumstance or situation, but the moment the wish surfaces is because of the here and now overwhelming feelings. This is our entry point.
The conversation starts by telling your kid you want to talk with them about suicide, and then, with something like “tell me about the times you have wished you could just be dead”.
First, let them tell you about what events/experiences trigger the wish to be dead/disappear/not be alive. For my son, it was fairly common themes, like when overwhelmed by homework, or having just been in a fight or argument with one of his parents. For some kids it may be related to friendships and romantic relationships. For young people questioning their sexual orientation or gender, these feelings and fears related to difference/uncertainly and acceptance are common sources of a deep desire to escape their situation.
It is imperative that we try to remember the times we have wished we were dead. It might have been decades ago, or it may have been in the middle of a fight with our partner last week, but it is essential that we remember that the wish to escape is normative. If we are not plagued with this wish, it is because we have learned something about how to manage these moments. Remembering our own experiences will help us not invalidate or diminish their experience. We would need to remember that their feelings seem out of proportion, because they are. But that is what feelings can be like, and that is the skill set and perspective we need to impart.
The big teaching about the wish to escape is that the largess of the feeling will pass. This is a crucial understanding about emotional disregulation. It isn’t that the feelings aren’t real. It is the the largeness with which we are feeling them is episodic. As filled as we may be in one long moment with fear, hate, grief, disappointment, self-loathing, etc, and even though we may have felt these feelings many times before, the intensity of the feelings will pass and other feelings will be free to surface and even take precedence. Talking to our teen in a neutral moment, when they are not filled with desperation and despair, is a great time to help them remember that as real as those feelings were, they have since had other feelings too.
The most terrifying possibility about suicidal ideation is that our teen could choose to kill themselves in a moment of being overwhelmed and flooded, an outcome they would not wish any other moment of the day/week/month. We must help them to understand that big feelings, though they hold important truths, do not hold all the truths. We need to remind them about the other feelings they have felt since those moments they wanted to die. We need to help them think about how even after those moments, when they were sure they would never feel any less hopeless, that they have laughed, and had fun, and chilled out with friends, fallen in love with new music, and watched some favorite tv shows.
After your teen has talked about the times they have wished they were dead, see if you can share times you were flooded and overwhelmed, disregulated and wanting to escape your feelings. Share with them the things you do to remind yourself that you won’t always feel that way, to calm yourself down and get yourself grounded. Help them understand it is a common experience and one that we can develop skills to manage. And ultimately, that we will learn that these feelings are temporary, and that other truths will surface.
Suicide as Escape of a Situation
Some teens have a very real situation going on in their lives that they feel routinely desperate and hopeless about. A leading cause of suicide in teens is questioning of sexual orientation and/or gender identity. Their concerns about how to navigate their identities in their families, friend groups, school setting and society at large are on-going dilemmas that plague them with hopelessness and uncertainty. Teens in families were they are experiencing physical/emotional/sexual abuse are also frequently plagued by repeated suicidal ideation. Teens emotionally neglected, too afraid to share their internal experiences with their families, left to handle the emotional burdens of life without adult support are also at high risk for ongoing suicidal ideation. Kids with learning and educational differences, similarly can be plagued by feelings of ineptitude and self doubt that lead to suicidality.
When there is a concrete external situation that the teen is facing on a daily basis, learning how to get though a particular moment of flooded emotionality isn’t enough. This teen is at significantly higher risk for suicide. They may well be actively suicidal, with a plan they are considering implementing. This teen requires immediate intervention. They need a therapist to further assess their suicidality. They may need an inpatient or outpatient program to triage the situation. They will likely benefit from medications to help reduce the intensity of their experience. If they have a family capable of support and change, they will benefit from family therapy.
Longer term, after an intervention has happened to contain the immediate suicidality, they need to know that this period of their lives is not going to be the only period of their life. They need to be supported and reassured that there will be other chapters in their life, ones where they have more influence over who and what is in their lives.
Many in our society idealize youth, and often suggest it is the best time in ones’ life. While there may be some idealistic aspects of youth, it requires a good fit between the child and the family, a life circumstance with minimal trauma and burden, and a societal frame that supports the particular child. Absent of this, adulthood offers significantly more options for crafting a life reflective of the life the young person hopes to live. We need to send this teen the resounding message that “It Gets Better”.
In 2010 the It Gets Better Project was launched to support LGBTQI teens around the world. While it is specially designed for the LBBTQI community, I often refer people to these amazing videos of hope, from celebrities and others, about what changes over time can help us access a new life with new possibilities.
When discussing suicidality with our teen, it might help if we are also able to discuss what was hard for us in childhood and what we did to build a different life. It is worth talking about the ways we built a life we love, and the ways we still do.
Suicide As Communication
One of the prominent feelings during suicidal ideation is that no one understands us. When our children are feeling isolated, alone, and misunderstood, they are also filled with resentment about the ways we and others do not understand them. This resentment and suffering, feelings of isolation and betrayal, can fuel their suicidality. In their longing to be seen and understood they may want to use their death to finally prove just how much pain they have been struggling with, and to punish us for having not seen.
This often gets characterized, especially when it is a failed suicide attempt, as a person who “just wants attention”. This is a cruel characterization that does not capture the pain they are in and their horrible experience of not having been adequately seen. We all long to be seen, especially our pain. For teens, they are in the horrible conundrum of having started a separation process with parents who may or may not have been able to sufficiently see them, to seeking new friends for their emerging identities who they long to be affirmed by.
When talking to our teen about the times they have felt like they didn’t want to be here, we should pursue the conversation to extract this part of the inner dialogue. We should specifically ask them about resentments about not being seen, about feeling like we don’t understand how much they are suffering.
The truth is that it is hard to understand the bigness of teens feelings. We have been fortunate enough to learn more self regulation. I remember when my son was a toddler and we were at a party with my friends. He started crying and screaming saying “I want to go home”. Before I got up and scooped him up to take him home, we all burst out laughing, and marveled at how great it would be if we were allowed to have the same level of meltdown when we had a random feeling or desire. Ou teen isn’t a toddler, but they aren’t an adult either. Learning how to handle big feelings is a long process. We need to be loving and supportive as we help them learn those skills, and serve as auxiliary ego support during the process.
Be brave. Be very very brave. As scary and disregulating as this conversation is, we can help our teens develop a frame for understanding how to handle hard emotions and difficult chapters in their lives. And it may well save their lives.
Smith is an analytically oriented psychotherapist with 25 years in practice. She is additionally the Founder/Director of Full Living: A Psychotherapy Practice, which specializes in matching clients with seasoned clinicians in the Greater Philadelphia Area.
If you are interested in therapy and live in Philadelphia or the Greater Philadelphia Area, please let Full Living: A Psychotherapy Practice match you with a skilled, experienced psychotherapist based on needs and issues as well as personality and style. All of our therapists are available for telehealth conferencing by phone or video in response to our current need for social distancing. Request an Appointment Today.
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