Understanding Youth “Suicide”

By Dr David Laing Dawson

Our assumptions and the language we use, that we so quickly use, often hinder a fresh and more useful way of viewing a problem. The word “suicide” and the phrase “attempted suicide” are examples of such assumptions and language.

This word and this phrase carry assumptions of intent, a formed intention, an intention to engage in an action that will achieve a goal. With the word “suicide” we imply that the goal is death, the ending of a life.

In the newspaper, and equally in medical charts, the phrase “attempted suicide” is poorly applied to many behaviours that were not “attempted suicide”. For many “attempted suicides” by teens, and some adults, the goal is not death, but …. Well, many things: payback, “they’ll be sorry”, negotiating power and control, making a point, taking a break, sleeping for a while, avoiding, revenge, punishment, getting someone to care, stopping the emotional pain…. Even when the goal is “death”, for a teenager, this can be a very ill-formed concept of death (complete with the idea of being around later to watch other peoples’ reactions), or a very drastic solution to a relatively small and temporary problem.

When the goal is not “death” and yet we call it “attempted suicide”, our interventions will be ill formed and misguided. In fact, I will make the case that when we mistake a teenager’s “getting someone to care”, or “punishing a boyfriend” for a “suicide attempt”, we mental health professionals find ourselves ratifying self harm as a legitimate tool of social discourse and problem solving.

But what is “death” to a ten year old, to a 14 year old? What is “death” to a Catholic or a Moslem?

Some years ago the uncle of a young boy killed himself by hanging. The boy was taken to the funeral of his uncle; he was privy to the conversation and distress of his own parents. And then the boy hung himself.

The community was understandably distraught. His teachers, family, friends, and the social workers working for the school board.

I was asked why an 11 year old would commit suicide? Was it a suicide? Could they have prevented it? I gave it some thought and reassured them that it was “an accident”, a tragic accident, not suicide.

For is it possible for an 11 year old to formulate a goal of being dead? Meaning “dead, dying, and death” as adults mean these words? No. For the boy in question we can never know how much was curiosity, imitation, how much distress, how much distracted parents, what he imagined he was actually doing. I am sure, that at 11 years of age, he did not have in his mind a clear and mature sense of the finality of death.

I am writing about this because of recent news reports of deaths of children age 10 to 14 in two northern Saskatchewan Communities. The reports are labeling these deaths “suicides”. They are also saying many other youth have “attempted suicide.” The responses have apparently been to send in mental health counselors, and to fly one or two out for psychiatric assessment. And these responses go along with the assumption that these children did in fact “commit suicide” and are in fact “attempting suicide.”

Now no doubt they are engaging in behaviours that have the potential to kill them, and that did so in four cases, including the most recent 10 year old. But that is what they are actually doing, these children; they are engaging in behaviours that can result in death. They are too young to know what that actually means for themselves, and for their families.

We do need to send a team in to investigate, but without the assumption that these behaviours constitute either “suicide attempts” or “suicide”, in an adult sense. We should investigate without the assumptions carried by those words.

Exactly what behaviours are these children engaging in, where, how, and why? And then, how can it be stopped. Or what needs to be done to change these patterns of behaviour?

 

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4 thoughts on “Understanding Youth “Suicide”

  1. I agree with your premise that not everyone who ‘commits suicide’ or ‘dies by suicide’ or ‘tries to commit suicide’ is intentionally trying to die. Certainly young children and adolescents do not really know what this means and often do it to achieve another end eg get attention, ease the pain, teach someone a lesson, etc. But then this begs the question of ‘What do we call it’? Often we use ‘died by suicide’ instead of using the word commit, but even this is inaccurate in your description since suicide means ‘to intentionally kill oneself’. So the question becomes how do we talk about it? Can we even talk about self-harm if someone is really using it to hurt someone else or ease their pain? Or should we instead educate people about the reasons for suicide and self-harm, and the need to address it, especially with children, when they are exposed to it. It’s difficult to do either. You either need to have everyone agree on an alternative way of referring to the event/action or you need to educate everyone about what you need to know about it and how to prevent it. I think you may get closer to the goal you are looking for if we all work on the latter.

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    1. Posted on behalf of Dr Dawson:

      I would like to see the phrase “attempted suicide” removed from the notes and consultations of psychiatrists, psychologists, emergency doctors, social work notes, nurses’ notes, unless the act being described was truly an “attempted suicide”. More accurate descriptions of behavior can be used in those contexts. Such as, “Having received via Snapchat from her then best friend, a picture of her boyfriend with another girl, she fetched some of her mother’s antidepressant pills from the medicine cabinet, swallowed them, and then posted this on her Facebook page. Several of her friends called her mother who brought her to the hospital.”

      All too often I see, in charts, the phrase “attempted suicide” followed quite logically by the diagnosis, “major depression”, when neither is accurate or useful.

      (It is also very seldom useful to ask anyone why he or she engaged in any behaviour, with the exception of course, of the common parental inquiry: “What on earth were you thinking?”)

      It is more difficult to imagine what could replace these phrases in media reports. If the child or adult dies perhaps the actual cause of death could be reported instead: “drowning”, “self-inflicted gunshot wound”, “overdose of prescription medication.”

      For “attempted suicides” phrases such as “self injurious behaviour” or “potentially lethal behaviour” could be used.

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