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All about psychology > Suicide, Fiction and Reality . . . Help??

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message 1: by stephanie (new)

stephanie (furies) | 8 comments i read a lot of YA in addition to everything else, in part because i work with kids and also because i like to see how different authors deal with "big" issues for different audiences.

i recently finished reading Thirteen Reasons Why, which features a girl who committed suicide leaving behind 13 taped people/events that led her to eventually decide suicide was it.

in my opinion, it's one of the best true to adolescent suicide stories i've come across. and yet it seems to be getting negative reviews across the board because most people don't believe that the character, hannah, would have committed suicide in the first place.

i don't know if any of you have read the book, but i am seriously unsettled by this view. apparently, if you haven't dealt with personal rape, abuse, bad family life, drugs, violence, etc. you are not a "viable" candidate for suicide. you need to basically have had something that would qualify you for PTSD by anyone's standards in order to be an accurate portrayal of suicide.

i don't know about all of you, but i have found that the most dangerously suicidal persons are the ones that have relatively normal lives. that they are depressed not because one single thing happened to them, but that it was an accumulation of things - and often times, the guilt that they are even depressed in the first place, because what right do they have to be depressed when their lives are so great on paper? when there are people starving in the sudan?

i know i have a particular view on this though because the clients that i interact with the most are usually well off NYC kids, or women with BPD, etc. ironically, i don't do a lot of suicide work with the kids that everyone assumes should be suicidal - i do more anger management/crisis resolution stuff with them.

but i wanted to know if anyone else had any thoughts/experience on the topic. do you think it's wrong or inaccurate to portray a suicidal character as a functioning depressive without any major PTSD-type events that we know of?

because i'm personally a little scared - suicide rates keep going up, and if the message is, you don't even deserve to feel suicidal, i think our youth is in even more trouble.

message 2: by James (new)

James | 59 comments A fairly high percentage of the whole population at least consider suicide at some point or other in life, and the three highest-risk demographics are (1) adolescents, (2) seniors, and (3) alcoholics and addicts. So it's just not true that only traumatized people are at risk for suicide.
And if someone is feeling a given emotional state, he/she is feeling it - talking about what a person 'should' feel or is 'entitled' to feel is useless and non-therapeutic. If someone wants to take that approach, he or she has no business in a helping profession.

I worked on a suicide prevention hotline for a couple of years, and in a suicide awareness and prevention program for leaders in the Marine Corps for three more years. I learned a lot from a very good psychiatrist who organized and led that program.

There are four primary psychological risk factors for suicide, and you can essentially take a person out of the high-risk category if you can help him or her reduce any or all of them. They are:
1. Emotional pain - the person is in a great deal of psychological distress. This may be hard to reduce, unless you can offer a solution to their problem(s) they didn't have available or didn't know about.
2. The belief that death is the only way to relieve the pain. You may or may not be able to help with this, depending on whether you can offer solutions they didn't know about or hadn't thought of.
3. The belief that they can't take it - the person thinks of himself/herself as being unable to cope with the emotional pain. Often you can help with this, by getting them to think about other hard times they've overcome and/or about role models who've dealt with hardship in ways they can emulate.
4. Emotional isolation - the belief that they don't matter to others, maybe that others might be better off without them, and/or that no one else knows, understands, or cares about what they're going through. THIS is the golden opportunity for intervention - if you can connect emotionally, you can reduce this isolation, and thereby directly reduce the risk of suicide. And you can connect just with active listening - if you can get them talking, keep them talking, and validate that their feelings are legitimate, you can help them stay alive. There were many times when someone called the hotline and after 30 or 45 minutes of conversation, even though their situation was unchanged otherwise, they would say that they felt much better and it had been the help they needed and they'd be okay now.

For that, you don't have to have PTSD, you don't need extensive or esoteric education or training. You just have to care and be willing to offer patient active listening, understanding, and unconditional acceptance and encouragement.

As to external or situational risk factors, the #1 trigger is a relationship breakup or crisis - and who goes through more relationship dramas than teenagers? #2 is financial trouble. Then there are a host of situations involving, basically, instability or risk of loss in any areas that are important to people's lives - work, health, etc.
Personal risk factors include being in one of the 3 demographics mentioned - adolescents, seniors, and people with addictions; being a loner; being an adrenaline junkie; having easy access to guns or other means of quick and impulsive self-harm; depression or other psychological/emotional problems; bereavement, especially via suicide; a family history of suicides; a personal history of previous attempts; or a recent major change in life circumstances, sometimes even a positive one like a major promotion at work. As for time of year, spring is most dangerous, because most major depressions last months and are at their deepest about 3 months in, and more major depressions have their onset at midwinter.

The most important thing is for people who notice that a friend or family member seems depressed to follow the impulse to reach out - ask them how they're doing, and if you're concerned that they might hurt themselves, ask specifically. It's a myth that bringing up the subject increases the risk - it drastically reduces it. If they are thinking about suicide they probably want to talk about it, but are afraid they will be judged, shunned, or laughed at. If they are approached by someone willing to talk about it in a calm, accepting, non-judgmental way, it can be the biggest relief in the world.

message 3: by Blair, The Dr. (last edited Sep 05, 2008 08:52AM) (new)

Blair (blairkilpatrick) | 14 comments Mod
I saw this book in a local bookstore over the weekend. The premise sounds troubling to me, somehow.

Yes, statistics do suggest many (perhaps most) people have at points in their lives experienced some fleeting suicidal thoughts. Adolescence is certainly one of those times. So it is important to talk about this experience and write about it. Most people, fortunately, are able to refrain from carrying the thoughts to completion, especially if they seek help.

I'm troubled, I guess, at the thought of teens reading a compelling novel in the form of a journal that ends in suicide. Here is why: It's not such an easy or comfortable thing to enter into the subjective world of someone who is deeply troubled and despairing, even for professionals, who are trained to empathize and still maintain sufficient boundaries to avoid being overwhelmed.

One other thing: the diagnostic group where the risk is greatest is not major depression, as many assume. It is bipolar (manic-depressive) illness. The poor judgment and lack of impulse control that go along the manic phase create a much greater risk of acting on suicidal thoughts.

(I'm a Ph.D. psychologist; have been a psychotherapist for over 25 years.)

message 4: by stephanie (new)

stephanie (furies) | 8 comments the book is actually written as a person on the tape (the boy who was in love with hannah) listens to the tapes she left behind. so it's both dealing with the aftermath of a suicide, and the reasons that drove the person to suicide in the first place.

i don't think that suicide was glorified, at all, but apparently many other readers do, so that's why i was curious. most people hated hannah and her decision - but she herself said that she understood that. that suicide is selfish, etc. hannah is NOT a particularly likeable character - especially because she decides (in the beginning) to leave these tapes as a type of revenge - a look how you fucked my life up and drove me to this -thing.

so most people just hate her and think the book isn't an accurate representation of adolescents and suicide at all. which is where i was wondering if my bias because of the kids i work with factored in to my thinking that this was a book full of excellent insight.

i agree that bi-polar persons are more at risk because of the impulsivity, but this was the first YA book i had come across where the suicidal character wasn't bi-polar or had some traumatic life event, and it bothered me that because of the absence of that, the fact she committed suicide was beyond belief. if that makes sense?

also, one of the tapes deals with the fact that hannah did bring up the fact she was thinking about suicide, anonymously, in one of her classes. and her peers rejected the whole thing and said whoever wrote it was just doing it for attention, and basically refused to discuss suicide as a possibility, which made hannah feel even more isolated.

it's very interesting to think about. for example, i don't like the idea of teen girls reading "gossip girl" and thinking that's what life is, and yet they are best-sellers. and what we do when we give books that deal with these "big" topics like suicide and death and drugs, etc. is almost even more fascinating.

oh, the intersection of fiction and psychology and developmental growth!

message 5: by Blair, The Dr. (new)

Blair (blairkilpatrick) | 14 comments Mod
Thanks for clarifying, Furies. The book sounds very interesting and probably well done. And different from what I'd worried about, if the girl who commits suicide is presented in such an unsympathetic light. Writing from the point of view of a survivor seems like a very good way of balancing the book. Perhaps I'll read it. (It would be my first YA book in--oh, about 40 years :-)

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