Section II. Our scenario continues with the older daughter taking her own life.
To the shock of her mother and family, [she] locked herself in her bedroom on a Saturday night. She swallowed a bottle of her grandmother's prescription medicine. When [she] did not come down for breakfast on Sunday morning, her mother banged hard on the locked door. When there was no response, her step father pushed the door in off of its hinges and entered the room. The mother ran to her daughter's bed and found her hidden under the covers in a fetal position. The mother was frantic as the step-father called 911. There was nothing that the paramedics could do. There was no pulse and the body was already cool. [She] was dead.
This section of research will examine five parts of this tragedy. The first part will discuss the facts about teen suicide to include: five reasons why the teen suicide rate may be up in America, eighteen signs that a teenager may be contemplating suicide, and seven strategies to prevent teen suicide. The second part will examine the role that depression and alienation plays in teen suicide. The third part will examine how to cope with the loss after a suicide. The fourth part will look at how the church can respond to suicide. The fifth part is an extended statement of one person's theology of suicide.
Facts about teen suicide in America?
Suicide is the eighth leading cause of death for all persons regardless of age, sex or race; the third leading cause of death for young people aged 15 to 24; and the fourth leading cause of death for persons between the ages of 10 and 14. Suicides among young people nationwide have increased dramatically in recent years.
Teenagers experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other fears while growing up. For some teenagers, divorce, the formation of a new family with step-parents and step-siblings, or moving to a new community can be very unsettling and can intensify self-doubts. In some cases, suicide appears to be a "solution."
It is important to take the subject of suicide seriously. It doesn't seem right that a teen-ager - who has lived for such a short time - would choose to die. But adolescents who cannot get over their depression sometimes do kill themselves. About nine percent have said they had tried suicide at least once.
Gender differences affect the means teens use to commit suicide. Girls, who are about twice as likely to attempt suicide as boys, tend to overdose on drugs or cut themselves. Boys, who complete suicide more often than girls, use firearms, hanging, or jumping more frequently. Because they tend to choose more sudden, lethal methods, boys are three or four times more likely to succeed in their attempts than girls.
The risk of suicide increases dramatically when teens have access to firearms at home, and nearly 60% of all successful suicides in the United States are committed with a gun. That is why it is imperative that any gun in a home be unloaded, locked, and kept out of the reach of children and adolescents. Ammunition must be stored and locked apart from the gun, and the keys for both should be kept in a different area from where household keys are stored.
Five reasons why the youth suicide rate gone up in recent years?
1. It's easier to get the tools for suicide
2. The pressures of modern life are greater;
3. Competition for good grades and college admission is stiff.
4. There's more violence in the newspapers and on television.
5. Lack of parental interest. Many children grow up in divorced households; for others, both of their parents work and their families spend limited time together.
Eighteen signs that a teenager may be thinking about suicide:
1. Has her personality changed dramatically?
2. Is he having trouble with a girlfriend (or, for girls, with a boyfriend)? Or is he having trouble getting along with other friends or with parents? Has he withdrawn from people he used to feel close to?
3. Is the quality of his schoolwork going down? Has he failed to live up to his own or someone else's standards (when it comes to school grades, for example)?
4. Is there a stressful family life. (having parents who are depressed or are substance abusers, or a family history of suicide)?
5. Has he seriously injured another person or caused anot
her person's death
(example: automobile accident)?
6. Is there a major loss; of a loved one, a home, divorce in the family, a trauma, a relationship?
7. Does she always seem bored, and is she having trouble concentrating?
8. Is he acting like a rebel in an unexplained and severe way?
9. Is she pregnant and finding it hard to cope with this major life change?
10. Has he run away from home?
11. Is your teen-ager abusing drugs and/or alcohol?
12. Is she complaining of headaches, stomachaches, etc., that may or may not be real?
13. Have his eating or sleeping habits changed?
14. Has her appearance changed for the worse?
15. Is he giving away some of his most prized possessions?
16. Is he writing notes or poems about death?
17. Does he talk about suicide, even jokingly? Has he said things such as, "That's the last straw," "I can't take it anymore," or "Nobody cares about me?" (Threatening to kill oneself precedes four out of five suicidal deaths.)
18. Has she tried to commit suicide before?
Seven Strategies to prevent teen suicide
1. If you suspect that your teen-ager might be thinking about suicide, do not remain silent. Suicide is preventable, but you must act quickly.
2. Ask your teen-ager about it. Don't be afraid to say the word "suicide." Getting the word out in the open may help your teen-ager think someone has heard his cries for help.
3. Reassure him that you love him. Remind him that no matter how awful his problems seem, they can be worked out, and you are willing to help.
4. Ask her to talk about her feelings. Listen carefully. Do not dismiss her problems or get angry at her.
5. Remove all lethal weapons from your home, including guns, pills, kitchen utensils and ropes.
6. Seek professional help. Ask your teen-ager's pediatrician to guide you. A variety of outpatient and hospital-based treatment programs are available.
7. Remember. Suicide victims are not trying to end their life - they are trying to end the pain!
Depression among teenagers
Related to suicide and usually leading up to suicide is depression. Depression has been considered to be the major psychiatric disease of the 20th century, affecting approximately eight million people in North America. Adults with depression are twenty times more likely to die from accidents or suicide than adults without depression. Major depression, including bipolar affective disorder, often appears for the first time during the teenage years, and early recognition of these conditions will have profound effects on later mortality in later life.
Recent studies have shown that greater than 20% of adolescents in the general population have emotional problems and one-third of adolescents attending psychiatric clinics suffer from depression. Despite this, depression in this age group is greatly underdiagnosed, leading to serious difficulties in school, work and personal adjustment which often continue into adulthood. Adolescence is a time of emotional turmoil, mood swings, gloomy introspection, great drama and heightened sensitivity. It is a time of rebellion and behavioral experimentation. All this makes diagnosis difficult.
When counseling with teenagers, confidentiality must be assured, but not to the point that the parents - who are often essential allies in treatment - are wholly excluded. Diagnosis may require more than one interview and is not a process that can be rushed. Inquire directly about possible suicidal ideas. The rules of confidentiality must be discussed with the teenager and the family to reach a clear understanding of which issues will be withheld. The teenager is an active participant in the treatment process and the counselor must identify the problem to the teen and parent, offer hope and reassurance, outline treatment options and arrive at a mutually agreed-upon counseling plan.
Depression appears in adolescents with essentially the same symptoms as in adults; however, some shrewdness may be required to translate the teenagers' symptoms into adult terms. Pervasive sadness may be exemplified by wearing black clothes, writing poetry with morbid themes or a preoccupation with music that has nihilistic themes. Sleep disturbance may manifest as all-night television watching, difficulty in getting up for school, or sleeping during the day. Lack of motivation and lowered energy level is reflected by missed classes. A drop in grade averages can be equated with loss of concentration and slowed thinking. Boredom may be a synonym for feeling depressed. Loss of appetite may become anorexia or bulimia. Adolescent depression may also present primarily as a behavior or conduct disorder, substance or alcohol abuse or as family turmoil and rebellion with no obvious symptoms reminiscent of depression. Formal testing may be helpful in complicated cases that do not lend themselves easily to diagnosis.
It is not uncommon for young people to be preoccupied with issues of mortality and to contemplate the effect their death would have on close family and friends. Thankfully, these ideas are usually not acted upon. Suicidal acts are generally associated with a significant acute crisis in the teenager's life and may also involve accompanying depression. It is important to stress that the crisis may be insignificant to the adults around, but very significant to the teenager. Thinking about suicide is more common among children who have already experienced significant stress in their lives.
There are two main avenues for treatment of depression: counseling/therapy and medication. Often, both may be required. The majority of mild depressions in teenagers respond to supportive counseling with active listening, advice and encouragement. Issues of alcohol and substance abuse may have to be referred to relevant agencies. Formal family therapy may be required to deal with specific problems or issues.
Referral should be considered under a number of circumstances. If the counselor cannot engage in conversation with the teenager because of the patient's resistance or the counselor's own insecurity about dealing with this age group, then referral is suggested. This is particularly important if the depression is judged to be severe or if there have been some suicidal concerns. Referral should also be considered if the teenager's condition does not improve in the expected time or if there is any deterioration or worsening of the depression despite adequate treatment. It should be stressed that the majority of teenage depressions can be managed successfully with counseling and with the support of the family.
Coping With Loss
What should a pastor do if a young person knows someone, perhaps a friend or a classmate, who has attempted or committed suicide? First, the pastor must acknowledge the teen's many emotions. Some teens say they feel guilty - especially those who felt they could have interpreted their friend's actions and words better. Others say they feel angry with the person who committed or attempted suicide for having done something so selfish. Still others say they feel nothing at all - they are too overwhelmed with confusion and grief. All of these emotions are appropriate; stress to the young person that there is no right or wrong way to feel.
When a young person attempts suicide and survives, the people around him may be afraid or uncomfortable about talking with him about it. The pastor should tell the supporting adults to resist this urge; this is a time when a person absolutely needs to feel connected to others.
When a teen commits suicide, other people around him may become depressed and suicidal themselves. A pastor should let the friends and family know that they should never blame themselves for someone's death; questioning whether they could have done something differently won't bring the friend or classmate back and it won't help them heal.
Many schools address a student's suicide by calling in special counselors to talk with the students and help them deal with their feelings. If a child is having difficulty dealing with a friend or classmate's suicide, a pastor may make use of these resources.
For parents, the death of a child is probably the most painful loss imaginable. For parents who have lost a child to suicide, the pain and grief may be intensified. Although these feelings may never completely go away, there are some things that survivors of suicide can do to begin the healing process. They can maintain contact with others. Suicide can be a very isolating experience for surviving family members because friends often don't know what to say and how to help. Survivors should seek out supportive people with whom they can talk about their feelings.
Remember that other family members are grieving, too, and that everyone expresses grief in their own way. Other children in the family, in particular, may try to deal with their pain alone so as not to burden a parent with additional worries. Each in the family should be there for the other through the tears, anger, and silences, and, if necessary, seek help and support together.
Survivors should expect that anniversaries, birthdays, and holidays may be difficult. Important days and holidays often reawaken a sense of loss and anxiety. On those days, survivors must do what is best for their emotional needs, whether that means surrounding themselves with family and friends or planning a quiet day of reflection.
Survivors should understand that it is normal to feel guilty and to question how this could have happened, but it's also important for them to realize that they may never get the answers you are looking for. The healing that takes place over time comes from reaching a point of forgiveness. The surviving parent must forgive the teen who committed the suicide. And just as important, and for the surviving parent must forgive himself or herself.
The Response of churches to suicide
Churches sometimes have denied funerals and memorial services to bereaved families. Victim's remains have been banned from cemeteries. Medical examiners have falsified records for families so they can receive economic aid.
Recognizing that the church's historical response to suicide includes punitive measures intended to prevent suicide and that there is no clear biblical stance on suicide, the Church should strongly urge the employment of major initiatives to prevent suicide. Additionally, the ministry of suicide prevention should receive urgent attention. The families of victims should also receive priority concern in the overall ministry of the Church. Harsh and punitive measures (such as denial of funeral or memorial services, or ministerial visits) imposed upon families of suicide victims should be denounced and abandoned. The church should participate in and urge others to participate in a full, community-based effort to address the needs of potential suicide victims and their families. Each local church should respond to issues of ministry related to suicide prevention and family-support services.
It must be emphasized that suicide increases in an environment or society that does not demonstrate a caring attitude toward all persons. The church has a special role in changing societal attitudes and the social environment of individuals and families. To promote this effort, the church should do the following:
1. Churches should develop curriculum for biblical and theological study of suicide and related mental and environmental health problems and promote the programs recommended by the American Association of Pastoral Counseling.
2. Churches should support public policies that: (a) promote access to mental-health services for all persons regardless of age, (b) remove the stigma associated with mental illness, and (c) encourage "help-seeking" behavior;
3. Churches should embrace all persons affected by suicide in loving community through support groups and responsive social institutions, call upon society through the media to reinforce the importance of human life and to advocate that public policies include all persons' welfare, and work against policies that devalue human life.
4. Churches should affirm that we can destroy our physical bodies but not our being in God, and affirm that a person stands in relationship to others. The loss of every person is a loss in community;
5. Churches should support childcare institutions that provide treatment for emotionally disturbed children, youth, and their families.
6. Churches should strengthen the youth ministries of the local church, helping the young people experience the saving grace of Jesus Christ and participate in the caring fellowship of the church.
Some thoughts about Suicide and Theology
by Thomas D. Kennedy published in Christianity Today, July 3, 2000.
Some years ago one of my better students came by my office for a chat. Several times before, she had talked of her troubled past. However, her faith had showed marked development. But on this day she announced that she had recently planned for her suicide. I was shocked and confused.
Suicide is confusing for Christians. Although the general thrust of scripture is clearly opposed to the taking of one's own life, it provides no clear disapproval of the few cases of apparent suicide it recounts. Suicide also confuses us because some of those we believe to be strong in the faith have considered it as a "way out."
Must we believe that hose who have taken their own lives suffer the eternal punishment of God? Nothing in scripture drives us to that conclusion. Of the seven or so suicides reported in Scripture, most familiar are Saul, Samson, and Judas. Saul apparently committed suicide to avoid dishonor and suffering at the hands of the Philistines. He is rewarded by the Israelites with a war hero's burial, there being no apparent disapproval of his suicide (1 Sam. 31:1-6). And while there is no hero's burial for Judas Iscariot (Matt. 27:5-7), Scripture is once more silent on the morality of this suicide of remorse.
The suicide of Samson has posed a greater problem for Christian theologians. Both Saint Augustine and Saint Thomas Aquinas wrestled with the case and concluded that Samson's suicide was justified as an act of obedience to a direct command of God.
Objections to suicide have a long history in the church. But the idea that suicide is an unforgivable sin is less easily traced. Among the church fathers, Saint Augustine was the most prominent and influential opponent of suicide. And early church synods declared that bequests from those who committed suicide (as well as the offering of those who attempted suicide) ought not to be accepted; and throughout the medieval period, proper Christian burial was refused those who committed suicide.
Saint Thomas Aquinas believed that suicide, by excluding a final repentance, was a mortal sin. Dante is likely to have influenced Christian thought at least as much as Saint Thomas, placing those who committed suicide in the seventh circle of the inferno. Luther and Calvin, despite their abhorrence of suicide do not suggest that it is an unpardonable sin. John Calvin is perhaps the most helpful on the issue, concluding that blaspheming against the Holy Spirit is the only unpardonable sin (Matt.12:31), and suicide need not be viewed as blasphemy. The pedigree of the view that suicide is unforgivable seems to lie in the medieval church and its distinction between mortal and venial sins.
We must understand suicide as free and uncoerced actions engaged in for the purpose of bringing about one's own death. Once we define it this way, it is easy to grasp the church's clear teaching throughout the centuries that suicide is morally wrong and ought never to be considered by the Christian. Life is a gift from God. To take one's own life is to show insufficient gratitude. Our lives belong to God; we are but stewards. To end my own life is to usurp that the prerogative that is God's alone. Suicide, the church has taught, is ordinarily a rejection of the goodness of God, and it can never be right to reject God's goodness.
If we define suicide as consisting of only free and uncoerced actions, we must ask a series of questions as we try to understand any particular suicide: To what extent do we know the suicide in question was genuinely free? Could pain (either physical or emotional) have coerced the individual to do what he otherwise might not have done? But even if we could know that an act of suicide was genuinely free, can we know that the aim of the act was indeed one's own death rather than a misguided cry for help? Can we know that the suicide believed this action would really kill?
These questions lead us to withhold judgment in many cases; but more telling yet is this question: Did the individual aim at removing himself from God's goodness by suicide? Was this an act of suicide directly aimed at saying no to God? Or was it rather a tragically misguided attempt at saying yes to God? Eternal punishment is reserved, Christians believe, for those who directly reject God and reject God as a consistent pattern in life, not merely in a solitary final act. Every suicide is not a rejection of God's goodness. Indeed, in many cases suicide is mistakenly chosen to bring one nearer to God. We cannot say that such a motive for suicide is correct. Nor can we say that a person who makes this tragic mistake has removed herself forever from the grace of God.
When I comes to dealing with suicide, the church must do more than teach about it, for the church's primary task is to be the people of God. First of all, the church must commit itself to being a community of truth, a community in which believers tell the truth about their own lives. A church must hear the stories of pain, suffering, and failure in the lives of its members; and those who tell the stories must receive from the church both lamentation and the healing balm of Christ. When the church is open and honest about pain and suffering, it can then confront in love even the most difficult of human crises and failures--suicide.
Second, the church must commit itself to being a community of love, not quick to judge. Since suicide often brings with it the stigma of "unpardonable sin" and feelings of shame and guilt for the surviving family members, those currently free of pain must welcome those who suffer in the name of Christ; and with the aid of the Holy Spirit, they must place themselves at one another's disposal. A church might well have a team ministry to contact and inquire daily about those who are troubled. A church might also designate certain gifted individuals to whom one might turn in distress. A community of love bears patiently with those who contemplate suicide and those who grieve and feel guilty as a result of suicide.
Third, the church must commit itself to being a community of joy, a community in which the new life of Christ is celebrated, a community that calls others to celebrate in the new life of Christ. By living as a community of joy, by regularly celebrating God's goodness to us in Jesus Christ, the church ministers to those who are saddened, joyfully acquainting them with the One who has known their sorrows.
My student friend seems to be doing well these days. This is due in no small part to the fact that she worships in a church that has been a community of truth, a community of love, and a community of joy. I am not sure she is able to give a clear theological explanation of her troubles; but I do think she know that her life is worthwhile. And this, with the Holy Spirit's aid, will sustain her.
Sources relevant to teen suicide on the World Wide Web (active as of 10/10/02):
The American Academy of Child and Adolescent Psychiatry (AACAP)
http://www.aacap.org/publications/factsfam/suicide.htm
Yellow Ribbon Suicide Prevention Program:
an outreach program of the Light for Life Foundation International
http://www.yellowribbon.org/
American Academy of Pediatrics
http://www.aap.org/advocacy/childhealthmonth/prevteensuicide.htm
American Psychiatric Association
http://www.psych.org/public_info/teenag~1.cfm
National Mental Health Association
http://www.nmha.org/infoctr/factsheets/82.cfm
Teen Suicide Theme Page
http://www.cln.org/themes/suicide.html
KidsHealth
http://kidshealth.org/parent/emotions/behavior/suicide.html
Bibliography of books that refer to teen suicide
Anderson, Luleen S. Sunday Came Early This Week. Cambridge, Massachusetts: Schenkman, 1982.
Blumenthal, Susan and Kupfer, Davis. Suicide Across the Life Cycle. Washington, DC: American Psychiatric Press, Inc., 1990.
Bolton, Iris. My Son, My Son. Atlanta, Georgia: The Bolton Press, 1983.
Collins, Gary R. Christian Counseling: A Comprehensive Guide. Dallas: Word Publishing, 1988.
Elkind, David. The Hurried Child: Growing Up Too Fast Too Soon. Reading, Massachusetts: Addison-Wesley, 1981.
Fleming, JE, Boyle, M, Offord, DR: The outcome of adolescent depression in the Ontario child health study follow-up. J Am Acad Child Adolesc Psychiatry 32(1):28,1993.
Friday, J.C., Ph.D., "The Psychological Impact of Violence in Underserved Communities," Journal of Health Care for the Poor and Underserved, Vol. 6, No. 4, 1995.
Hewett, J.H. After Suicide. Philadelphia, Pennsylvania: Westminster Press, 1980.
Hyde, Margaret O. and Elizabeth H. Forsythe. Suicide: The Hidden Epidemic. New York: Franklin Watts, 1987.
Klagsbrun, Francine. Too Young to Die: Youth and Suicide. New York: Pocket Books, 1984. (Good overview. Best on teenage suicide.)
Klerman, Gerald L. Suicide and Depression Among Adolescents and Young Adults. Washington, DC: American Psychiatric Press, Inc. 1986.
Lewinsohn, P, Gregory, M, Clark, N, et al: Major depression in community adolescents: Age, episode duration, and time of recurrence. J Am Acad Child Adolesc Psychiatry 33(6):809,1994.
Madison, Arnold. Suicide and Young People. Boston: Clarion/Houghton Mifflin, 1981.
Mark, John E. and Holly Hickler. Vivienne: The Life and Suicide of an Adolescent Girl. New York: NAI Books, 1982.
McCoy, Kathleen. Coping with Teenage Depression: A Parent's Guide. New York: NAI Books, 1982.
Offer, D, Schonert-Reichl, KA: Debunking the myths of adolescence. Findings from recent research. J Am Acad Child Adolesc Psychiatry 31(6):1003,1992.
Roy, Alec, editor. Suicide. Baltimore, Maryland: Williams and Wilkins, 1986.
Spillard, A. Grief After Suicide. Waukesha, Wisconsin: Mental Health Association of Waukesha County, Inc., no date. (Excellent pamphlet for suicide survivors. Send 50 cents to WMHA, 2220 Silvernail Rd., Pewaukee, WI 53072.
Weller, Elizabeth B., M.D. and Ronald A. Weller, M.D. Current Perspectives on Major Depressive Disorders in Children. Washington, DC: American Psychiatric Press, Inc. 1984.
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