An increasing
component of my work with adolescents involves assessing the risk of suicide.
Our first meeting often comes at a time of crisis; when a young person has
verbalised or acted upon suicidal ideation, perhaps by taking an overdose or
cutting themselves very deeply with intent. This communication is often met
with anger or confusion from parents and peers, which can lead to alienation.
Sometimes an adolescent’s suicidality is over-dramatized, while at other times
suicidal actions are dismissed as ‘attention-seeking’. In some respects that’s
right; suicidal acts do attract attention, but the implied assumption
that they need not be taken seriously is dangerous.
My role, as well
as assessing risk, is to take the suicidal adolescent seriously. Generally,
they value the attention of someone who is interested in them and their story
and this can lead to productive, long term therapy. Often it is their first
experience of thinking with another about their vague and bewildering
thoughts and feelings, which therapy can help make sense of.
I like the
definition of adolescence as a period of ‘sturm und drang’¹
(storm and stress). Instability and turmoil come with the territory, even for
those with a stable, loving family to help them navigate the way. Charged by
rampant hormones, the transition from childhood to adulthood brings forth
contemplation about life, the universe and everything, but mostly, if we’re
honest, musings about sex and death. This is both ordinary and terrifying.
Freud identified
an enduring conflict between Eros and Thanatos, the life and death instincts;
the former, sexual and self-satisfying, the latter, antagonistic and hostile².
Eros and Thanatos resemble adolescence personified when everything is perceived
as a matter of life or death. Indeed, the trigger for suicidal ideation is
often a relationship break-up, sexual confusion or poor self-image; experiences
which challenge the adolescent’s sense of self, question their meaning of life,
and intensify their sense of loss. With their childhood dying and their adult
life gathering speed, Thanatos and Eros are in battle.
So, when an adolescent
presents with suicidal ideation they are contemplating their own life and mortality. Thinking alongside
them about life and death can help to identify the internal alive and dead
parts, leading to resolution of the life/death conflict. The adolescent who is
taken seriously enough becomes less
fragmented, their desire to be dead diminishes and they are freed-up to
continue the journey into adulthood with alive, sexual potential.
1. Hall, G. Stanley. (1904) Adolescence: Its Psychology and Its
Relations to Physiology, Anthropology, Sociology, Sex, Crime, Religion, and
Education, Vol I and II, New York, Appleton
2. Freud, (1930) Civilization and its Discontents, London:
Hogarth Press and Institute of Psycho-Analysis. New York: Cape and Smith
Published in BACP Children & Young People March 2013
Published in BACP Children & Young People March 2013
