Let’s Rethink Suicidal Thoughts in Youth: Not Literal Edicts, Suicidal Thoughts Can Be The Brain’s Invitation to Solve a Personal Mystery
September was National Suicide Prevention Month. In the mental health trenches, however, every month, week, day, and hour is about suicide prevention. I’d like to offer a different perspective on suicidal thoughts in young people. Afterall, according to the World Health Organization, more than 700 000 people die due to suicide every year and suicide is the fourth leading cause of death in 15-19-year-olds (https://www.who.int/news-room/fact-sheets/detail/suicide).
Suicidal behavior—thoughts and attempts to end your own life—in youth terrify parents, caregivers, and sometimes the youth themselves. Suicidal behavior is listed as an official symptom of Major Depressive Disorder, the depressive episode of Bipolar Disorder, and Borderline Personality Disorder (though I’m hesitant to diagnose children and teens with a personality disorder as their brains are still developing). Children and teens with some type of anxiety disorder (Generalized Anxiety, Obsessive Compulsive Disorder, Panic Disorder, and/or Post-Traumatic Stress Disorder) often present with accompanying suicidal behavior. In addition, suicidal behavior can also accompany substance abuse disorders or, occasionally, other mental disorders.
Suicidal thoughts in the context of youth depression and anxiety are misunderstood. After safety is ensured, it’s essential to help patients and their parents discern what the suicidal thoughts actually mean. I go over the basics with them first.
Depression and anxiety are typically hardwired into brains.
Suicidal thoughts are therefore hardwired biologic symptoms, the same way wheezing is a biologic symptom of asthma. This is crucial for empathy building as suicidal thoughts aren’t character flaws or cop-outs. And just as weather changes or exercise can trigger wheezing in people with asthma—even well-treated asthma—being overwhelmed or feeling out-of-control can trigger suicidal thoughts in young people with depression and/or anxiety—even well-treated depression and/or anxiety.
Expect suicidal thoughts to recur when the brain is overwhelmed or feeling out-of-control.
Suicidal thoughts can be managed.
Then we dive into management of suicidal thoughts.
Suicidal thoughts are not literal edicts to kill yourself, so as intense and real as they seem, don’t act on them. Talk about them instead.
Suicidal thoughts are your brain’s tricky, secret code that something that needs to be said isn’t being said, or something that needs to change isn’t changing. For example, a ten-year-old I recently treated, his suicidal thoughts and attempts reflected a counterintuitive way to find control when everything in his life felt out of control (his parents were having scary fights in front of him and his brother, and there was talk of affairs and divorce). For an eighteen-year-old who was bullied since elementary school, her suicidal thoughts were years of bottled-up rage turned inward. A fifteen-year-old’s suicidal thoughts were internalized shame after years of being shamed or mocked by her parents.
What needs to be said? What needs to change? For the ten-year-old, it was learning to express his thoughts and feelings to his parents about their marital conflict. For the eighteen-year-old, it was learning to tell the internalized bully in her head to shut-up and learning how to speak up for herself against real-life bullies. For the fifteen-year-old, it was understanding that even though telling her parents what she thought and felt about their cruel words to her hadn’t made them stop, she could still learn to validate and find worth in herself.
Learning to manage suicidal thoughts can take time, but I tell my patients, it’s like learning to swim—the more they practice, the better they get. Once they comprehend that suicidal thoughts are their brains’ tricky, secret code that needs decoding, they find empowerment in the decoding, and managing future suicidal thoughts becomes possible.
Outside of the psychiatrist’s office, here are some of the basics of suicide prevention:
Know the sign and symptoms of someone thinking about suicide, such as: talking about wanting to die or kill themselves, talking about feeling hopeless or having nothing to live for, making plans or researching ways to kill themselves, talking about feeling shame, unbearable pain, or being a burden to others, using drugs or alcohol more often, acting different (more anxious, agitated, or withdrawn), more intense mood swings, giving away possessions, or saying goodbye.
Know the risk factors, such as: depression, other mental disorders or substance abuse disorders, some medical conditions, chronic pain, a prior suicide attempt, family history of a mental disorder, substance abuse, or suicide, family violence and/or abuse, having guns in the home, or being exposed to others’ suicidal behavior (like a family member, friend, or celebrity).
Have an action plan.
Listen and talk with the person. Ask them if they’re thinking about killing themselves. Asking directly “Are you thinking about killing yourself?” doesn’t make them do it.
If the suicidal person has a plan, try to get them away from lethal items or places.
Connect them.
National Suicide Prevention Lifeline 1-800-273-TALK (8255)
Family member or friend
Mental health professional
Keep in touch with them if possible.
