International Journal of Offender Therapy and Comparative Criminology http://ijo.sagepub.

com/

Teenage Suicide: A Search for Sense

Donald McGuire Int J Offender Ther Comp Criminol 1983 27: 211 DOI: 10.1177/0306624X8302700303 The online version of this article can be found at: http://ijo.sagepub.com/content/27/3/211

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Teenage

Suicide: A Search for Sense

Donald McGuire
Summary: Many misconceptions about suicide are discussed and the predisposing factors leading to suicide or suicide attempts, . particularly in young people are outlined It is pointed out that , many people who want to kill themselves are only suicidal for a short period of time If they are saved from self destruction . they can go on to lead normal lives. Therefore it is essential to , recognize clues and warnings of suicidal behavior and to take active measures of intervention With a chronic pattern of . , repetitive self-destructive behavior the outlook is pessimistic and a long term rehabilitation plan is needed .

THE problem of youths taking their The philosopher-historian, Plutarch,

of Miletus who over without any apparent reason. He reports: The daughters of the citizens inhabiting Miletus at that time almost without exception took a sudden whim to commit suicide, without there being any obvious reason for it, and subsequently, many ended their lives by hanging themselves. Such incidents became daily more frequent, and when no cure was to be had for this demented persistance in dying, the Miletians introduced a regulation that all girls who died by hanging themselves should be carried naked to burial, retaining the identical noose that had been around their necks. After this regulation had been made the girls no longer committed suicide, I deterred by nothing but the shame of such a disgraceful funeral. attitudes From the time of the ancient Egyptians to the present, about suicide have ranged from praise to condemnation. In early Rome, patricians who planned their own death had a party, cut their wrists and placed them in warm water and then drank wine until they died. This attitude toward suicide changed because of economics. When the slaves began to commit suicide, suicide became a crime against the state.2 In the Judeo-Christian tradition suicide 3 is a sin.3 Adolescent suicide went untreated as a mental health problem in the United States before 1950. Suicide research was neglected; neither the media nor the professional literature focused on the problem. Today suicide ranks as the nations third cause of death among adolescents. The Department of Health, Education and Welfares Bureau of Statistics states that 4,800 teenagers between fourteen and nineteen
211

lives is an ancient one. of the young girls two thousand years ago took their own lives
own

speaks

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years of age committed suicide in 1977-78; it is 4 that 420,000 attempted it.4

estimated, however,

Studies are not plentiful. Attempts are being made to document the incidence of suicide among the young. Dr. Cynthia Pfeffer, Assistant Professor of Psychiatry at Cornell Medical Center, recently studied 58 children between the ages of six and twelve years and found that 72 percent were suicidal. Dr. Pfeffer stated that the children claimed that &dquo;they wanted to die, they wanted to kill themselves&dquo;. They felt hopeless.s These are alarming statistics. Indeed, the shame and secrecy which surrounds suicide forestalls their seeking help and probably is responsible for inaccuracies in the suicide data. No one knows how many attempts go unreported and how many deaths are &dquo;covered-up&dquo;.6
Pressure on the Young In considering the self-destructive impulse in the young, depression seems to be the most important consideration. The depressed child or adolescent feels isolated, unwanted and unloved. This painful feeling of abandonment is frequently shown by withdrawal. For example, often in the classroom the child who is going through crisis or who acts-out gets the attention. However, the child who retreats into herself is left (all too often) untouched. A sense of failure and rejection stalk the depressed. The pressures in contemporary society are extreme. Media extends the range of crises that are introduced into childrens daily life. The American family structure is experiencing a variety of pressures. Problem Definition Defining suicide is difficult. Suicidologists interpret suicidal threats and acts of self-injury as attempts to communicate. Karl Menninger commented that &dquo; the suicidal act is sometimes a kind of insincere playacting and that their capacity for dealing with reality is so poorly developed that they proceed as if they could actually kill themselves and not die.&dquo; There is no intent to go through with it. It might be a cry for someone to care. Motives for suicide include seeking contact and moving toward others. The time of the cry for help is the most opportune time to intervene because the child in crisis is fluid and susceptible to change. Therefore, it is critical that help be immediate.7 Grollmen feels that to be declared a suicide a person must intend to kill himself and actually do it.8 Durkheim says the term may be &dquo;applied to all cases of death resulting directly or indirectly from a positive or negative act of the victim himself which he knows will produce this result.&dquo; An attempt is an act thus defined but falling short of actual death.9 Questions arise. Does an attempt
..

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213
as its motivation the desire to diel is asking for help or may have wanted possible person temporary relief from a stressful life situation or emotional pain? It is not surprising that anything so shrouded in secrecy and guilt has so many myths associated with it. Some of the more common myths along with actual facts are as follows: 1. Children who talk about suicide wont commit suicide. However, three quarters of people who committed suicide had either attempted it or threatened to or both. All threats and attempts must be taken seriously. 2. Suicide happens without warning. To the contrary, results of many studies conclude that the suicide person has given many clues and warnings beforehand. It is important to become sensitive to what these clues and warnings are. 3. Improvement after a suicidal crisis means the suicide risk is over. Not withstanding, during the critical period of about 90 days after the suicidal crisis about half of those people who attempt suicide subsequently commit it. 4. Suicide and depression are synonymous. In actual fact, a suicidal person may show symptoms of anxiety, depression, psychosis, organic impairment, and so on, as well as depression or instead of it. However, depression is the best indicator of a potential suicide. 5. All suicide persons are insane. Not at all, the majority of people who commit suicide are tormented and ambivalent but are not insane. Most would be classified as having a character disorder or neurosis. 6. Suicide is a single disease. Actually it is expressed in many different ways and appears in all ages, both sexes and all economic levels. It can occur in many degrees with many motivations, with different meanings, and various degrees of lethal intent 7. Once a person is suicidal, he is suicidal forever. In point of fact, people who want to kill themselves are only suicidal for a period of time. If they are saved from self-destruction they can go on to lead normal lives. 8. Suicide is inherited. Quite simply, it is not.ll or a success

necessarily have
that
a

Is it

Theoretical Views Why should a child want to kill himself or try to take his/her life? Freud believed that within all of us there are two instincts. Eros (life) and Thanatos (death). He believed there is a constant shifting of power between the two. Adler thought the suicidal person is inferiority ridden and is one who &dquo;hurts others by dreaming himself into injuries by administering them to himself&dquo;. Jung believed that suicide is an unconscious longing for rebirth. Sullivan looked at the individual and his relationship to others. He believed

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214

this relationship is crucial. The individual has three personifications

of &dquo;me&dquo;: good me (in security), bad me (in anxiety), not me (in psychotic nightmares). The individual evaluates himself in terms of others reactions to him. When security is threatened and anxiety unbearable, he may want to transform the &dquo;bad me&dquo; into &dquo;not me&dquo;. Horney thought suicide results from childish dependency and from deep rooted inferiority feelings. Durkheim, in his book Le Suicide 1897, stated that suicide is a reaction to the peculiarities of society. He outlined three types of suicide: 1. Egotistic-person has few ties in the community, there is a relaxation of religious, political and social controls, and the person is not sufficiently integrated in his society. 2. Anomic-Failure to adjust to social change, i.e., business crisis, economic depression. 3. Altruistic-person sacrifices his life for his community. The group has authority over the individual.12 Karl Menninger believed that suicide arises out of three wishes: the wish to kill, the wish to be killed, and the wish to die. The wish
to kill is based on a resentment and fear of anyone who is a threat to comfort and satisfaction accompanied by the wish that originates

The wish is inhibited except in some criminals, some and some primitives. However, in most people the destructive impulses against others or self are neutralized, making them no longer murderous, but constructive and creative. Menninger feels that in a sense procreation (the act of coitus) is the polar antithesis of murder. A more complete fusion of constructive and destructive impulses results in positive attachment to objects in the environment. A capacity to discriminate between friend and foe develops. Personality growth, social capacity, and creativity are only possible when aggression is directed outward rather than inward, focused upon proper objects of attack, neutralized by love. In suicidal behavior, Menninger assumes that the aggression is not neutralized with love or constructive impulses. It breaks loose, and the person sacrifices his own life to demonstrate his hatred of another. He cannot kill the other; he is too afraid or loves the other so much that he kills himself (therefore he kills the introjected parent, person). The wish to be killed is the extreme form of aggression. The demands of conscience in the wish to be killed becomes go great that there is no inner peace. In order to alone, the person must suffer. In the extreme, the person feels that he must die to atone. The wish to die is common in mountain climbers and daredevils, and in the mentally disordered who feel that they will find release from mental anguish by dying.13 Schneiderman categorizes suicidal behavior into four types: 1. Impulsive suicidal behavior-usually follows disappointment, anger or frustration.

in infancy. psychotics

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215

2. Feeling that life is no longer worth living. Usually results from depression. Youth believes his feelings of worthlessness and hopelessness will not go away and that he is seeing life the way it really

is.
3. Very serious illness. Altruistic aim of sparing loved ones the of caring for him. 4. Communication suicide attempts-youth does not really want to die but wants to change the way people act. It may be an attempt to win sympathy, interest and to express anger.14 Some youths feel life is intolerable and unmanageable. They engage in death oriented behavior or life shortening activities which are not ordinarily associated with suicide. However, they may be engaging in a &dquo;slow suicide&dquo; which may be partial, subintentioned, or a suicidal equivalent. Examples of these behaviors are overeating, alcoholism, heavy smoking, overworking and excessive risk-taking in automobiles. 15

difficulty

Empirical Views To begin to understand suicide, we must try to understand that something is happening within the youth and around him. Suicide often occurs when status is destroyed or shaken, when the youths whole personal ideology is threatened and exposed. He loses his perspective and balance. Sometimes he wants to kill himself because of guilt from the past or he cant accept his prospects for the future. The commonest precipitating factors in suicide in order of frequency are:
1. Poor health 2. Economic distress 3. Death of a loved one 4. Domestic problems and divorce Often the suicidal person acts out the hostile, anti-social impulses of the family. Often this person is singled out as an object of its pathology and accumulated aggression. The person cannot respond appropriately to the hostility so he turns it inward. The person must be understood in the context of his significant others and his rela.

tionship

to

them.16

Predisposition to Suicide Eighty percent of people admit

The
causes

to having had some suicidal ideas. have already been discussed. Yet, some people never attempt or commit suicide even though they must experience some of the same crises and stresses in their lives. Is it possible that there are some identifiable personality characteristics which predispose them to suicidal behavior? Degree of hope regarding the life situation has been analyzed by Farber in terms of a &dquo;sense of com-

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216

petence&dquo; postulated by Robert White. In essence, the greater the feeling of hope, the less likelihood of suicide. The amount of hope is increased when the feeling of competence increases, but decreases when acceptable life conditions are increasingly threatened. Suicides tend to be more negative about themselves than other people, more rigid, authoritarian, more prone to crises, and more prone to have problems in communication. Suicidal tendencies are not easily discovered on psychological tests, but are best predicted by studying behavior patterns such as insomnia, and feelings such as anger or depression. Research indicates that the thought processes of suicidal people seem rigid; everything is black and white,
with no shades of gray. The suicidal person may have some distortions of concepts, especially the self concept.17 It is essential for the layman and clinician to recognize clues and warnings of suicidal behavior. The great majority of suicides go through a pre-suicidal phase which would include verbal threats, attempts, a sudden behavior change (depression and/or an increase in barbiturate and/or alcohol intake). Verbalizations such as &dquo;Im tired of life&dquo;, &dquo;My family would be better off without me&dquo;, &dquo;Life has lost all meaning&dquo;, &dquo;I want an out&dquo;, &dquo;I wont be needing anything&dquo;, are danger signals. Certain behaviors may be indicators that a person is planning to take his/her life. For example, the youth who gives away his prized records or books. Depression, trouble eating, trouble sleeping, physical complaints, profound feelings of worthlessness, a recent disappointment or loss. Has there been a recent attempt at suicide? Twelve percent of those who attempt it will try it again and succeed in two years. 18 In a clinical assessment of self destructive potential, questions should be asked as to age, sex, recent illnesses and any recent losses of significance sustained. Are there clinical signs of depression, psychosis, ability to communicate? Threats made by males should cause more concern. The older the male the more serious the potential for self destruction. In females, attempts made by those between 15-35 years of age are often not a desire for &dquo;death&dquo;, but a &dquo;cry for help&dquo;. The more acute cases need more active intervention. With a chronic pattern of repetitive, self-destructive behavior the outlook is pessimistic, especially as the person grows older. Crisis intervention has no lasting effect with this type of person. A long term rehabilitation plan is necessary. If a person has made a choice of time, place, method, the danger is very serious. Plans to use a gun or to jump off a bridge or building is more serious than taking aspirin or cold tablets. The most serious suicidal potential is when a person feels helpless, hopeless, exhausted and a failure with the feeling &dquo;I just want out&dquo;. A combination of agitation and confusion especially in a person with previous psychotic episodes may constitute an emergency.

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REFERENCES
1. Plutarch, (1969) Moralis (F. Sandback, Ed. E trans.). Cambridge: Harvard University Press, p.311-312. 2. Gibbon, E. (1952) The Decline and Fall of the Roman Empire (Vol. 2), Chicago: Encyclopedia Britannica. 3. Codex juris canonici (1918), Rome (Italy) : Polygot Press. 4. U.S. Department of Commerce, Bureau of the Census, Statistical Abstract of the United States (1978), Washington D.C.: Government Printing Office. 5. Pfeffer, C. (1979) The Six Year Olds Try Suicide, New York Post ,

May 14, p.24.

6. Grollman, E. A. (1971) Suicide Intervention Postven, Prevention , — , tion Boston : Beacon Press, 17-18.
7. Menninger, K. (1966) Man Against Himself New York : Harcourt , Brace (1983). Grollman, ibid 6, p.9. 9. Durkheim, E. (1951) Suicide A Study in Sociology Toronto: The , , Free Press, 44. 10. Schneidman, E. S.; Faberow, N. L. & Litman, R. E. (1965) The Suicide Prevention Center. In Norman L. Faberow & : Edwin S. Schneidman (Eds.), The Cry for Help New York: McGraw-Hill, 13-14. , 11. Lester, G. & Lester, D. (1971) Suicide the Gamble With Death , , Englewood Cliffs (N.J.): Prentice-Hall, 3-4. 12. Grollman, ibid 6, 18-40. 13. Menninger, K. (1938) Man Against Himself New York: Harcourt , Brace & World, 13-17. 14. Lester, ibid 11, 5. 15. Grollman, ibid 6, 10-12. 16. Ibid 6, 74-84. 17. Lester, ibid & 11. 11, 6 18. Grollman, ibid 6, 7-74.

Donald McGuire, Ed.D., ACSW Assistant Professor, Fordham University, Graduate School of Social Services, Lincoln Center, New York, NY 10023, USA

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