Sadness And Beyond: Psychiatrists Respond To Death Of Newton Teen

More than 1,000 origami cranes at a suicide prevention event titled 'Walk Out of Darkness." (US Navy on Wikimedia Commons)

More than 1,000 origami cranes at a 2012 suicide prevention event titled ‘Walk Out of Darkness.” (US Navy on Wikimedia Commons)

The news darkened Sunday for everyone it reached. Karen Douglas, the 18-year-old Newton North High School student who’d been reported missing on Thursday, had been found dead Saturday night in Natick. Official sources said only that the death was not “suspicious,” and did not appear to have been caused by foul play. But a heartbroken post on Reddit by Sonya Maria Douglas, who identified herself as Karen’s sister, was headlined without euphemism: “Karen Douglas found in suicide. Thank you Reddit for your prayers and actions.”

We asked Dr. Steve Schlozman and Dr. Gene Beresin to respond, and in particular, to offer guidance on how best to discuss and absorb such painful news. They are child and adolescent psychiatrists at Massachusetts General Hospital and are directors of the Clay Center for Young Healthy Minds.

By Dr. Steve Schlozman and Dr. Gene Beresin
Guest contributors

We’ve tried over and over to begin this post. We want to, need to and indeed feel we have an obligation to write about adolescent suicide following the possible suicide of a teen in Newton last week. Gene and I have read over and over the well-publicized, incredibly moving, and palpably sad Reddit post that the girl’s sister penned.

We’re just so very sad.

And that’s an okay place to start…really the only place to start. We could discuss the statistics, the risk factors, the phenomenon of copycat suicides. We could talk about early detection and prevention, and we could talk about community support.

Still, we too often leap to these numbers – solid things, measurable things – because we can’t imagine falling into the abyss of pain that these stories create. People suffer with illnesses; that’s the definition of illness. But a young life ending is heartwrenching, whether by suicide or any other means.

And suicide just feels different. We know that people who take their own lives are in immense pain. We know that the dark cloud of stigma hovers over those who suffer mental illness. We know that feeling suicidal can be intensely private. Those who take their own lives feel profoundly alone. We know as well that we are, paradoxically, herd animals…that we don’t do well when we’re alone. A condition that makes us feel as if we deserve to be lonely makes us suffer all the more. We are least compelled to reach out exactly at the time when we can be most powerfully helped by each other. And the suffering is often greater when we realize the pain it may deliver to those who love us. Even then, we can’t reach out.

Combine all that – the stigma, the pain, the swirling desperation and the sense of utter and desolate loneliness – and we retreat instead to our statistics and our epidemiology.

There will be time for those facts in just a few lines. But for now, let’s note, together, that we are sad and that we are saddened. It is impossible to move forward in the absence of that acknowledgement.

Remember that suicide is a symptom. It is not terribly common, thank God, but neither is it rare. Young people do not die often, so when we say that suicide is the third leading cause of death in teens and young adults (automobile accidents and homicide are the first two) we need to remember that this doesn’t mean that suicides happen with great frequency. According to the Centers for Disease Control and Prevention, youth suicide accounts for about 4600 deaths per year. It ought to be obvious that this is an intolerable number.

Ask around. Scarcely anyone makes it through middle or upper school without another student attempting serious self-harm. In fact, the CDC estimates that about 16% of kids contemplate suicide yearly and almost 8% make an attempt. In high-pressure environments, these numbers increase dramatically. Remember that “high-pressure” can mean poverty and deprivation as well as intense academic stress. Kids of all ilks are vulnerable.

And yet we don’t talk about suicide, and in many ways this makes serious self-harm quite similar to other forms of psychiatric suffering. One in five kids will suffer a psychiatric illness in their childhood or adolescence, and yet we almost never discuss this with them or each other. We can’t seem to acknowledge when the self, itself, suffers.

Does this mean that the presumed suicide in today’s papers could have been prevented? Could better education and greater tolerance have made a difference?

We can’t possibly know the answer to that query.

But we can say with certainty that by better educating the public about these issues, we stand a better chance of preventing further harm to more kids. Early detection and prevention studies have proven this multiple times over.

Suicidal thoughts and behavior are most commonly a symptom of a mood disorder. In fact, the three most common risk factors for suicide among kids are 1) a mood disorder, 2) substance abuse, and 3) a previous attempt. About 90% of kids who take their own lives meet criteria for a serious psychiatric illness. The most common illness that leads to suicide is Depression. Bipolar Disorder, early psychosis and substance abuse also increase risks.

Kids, though, are different from adults. They can be more impulsive. They can be rash. Breaking up with a girlfriend or boyfriend, not making the school play, a fight with parents or friends – all of these can, rarely, be enough to provoke self harm. That’s why substance abuse is especially dangerous. The disinhibition that substances afford make impulsivity that much more likely.

So we remain vigilant. We look for signs of depression or mania. We watch for substance abuse. We stand guard for kids who isolate, we worry for the kids who withdraw, who show academic decline or uncharacteristic lack of interest in typical activities, and we check on kids who post provocatively about suicide on the Internet. In fact, many potential acts of self-harm are averted today precisely because friends alert families when their buddy’s social media becomes frightening.

We also know that among teens there is a tendency to romanticize suicide. This is understandable; a desperate act with great potential publicity can be appealing to an adolescent brain. This is of course a general statement, and each episode of suicide is different. But never forget the tendency for kids to emulate that which they romanticize.

“Copycat suicide” is one of the most carefully researched, documented and proven facts about teenagers. It typically happens within two weeks after a well publicized suicide – often a celebrity, but also the suicide of a character on TV, in the movies, or someone written about online, in newspapers or magazines. These observations have led to specific guidelines about how best to report on suicide in the community. They draw from the fact that suicides are often copied by kids if the individual is idealized, if there is extensive coverage, a detailed description of the death, or if it is glamorized. These proscriptions are recommended by both the CDC and the American Foundation for Suicide Prevention (AFSP), and they include:

•Inform the public without sensationalizing
•Avoid providing excessive detail on the method
•Show the consequences for the survivors
•Don’t overestimate the frequency of suicide.
•Report on suicide as a public health issue
•Don’t give simple explanations of cause (“He was dumped by his girlfriend and killed himself; or he was fired from his job and shot himself.”)
•Give information on sources for help
•Don’t refer to suicide as “successful” or a “failed attempt,” rather “she died by suicide” or “killed herself,”

Finally, and when tolerated and tolerable, we support one another. Coming together as a community is a long-established cultural tradition. That’s why we sit shiva; that’s why we have wakes. But just because we desperately want to help, it doesn’t mean a family wants or needs it at the moment. Some do, but others need private space and time. If a family requests to mourn in peace, let them do so. If a family feels they need help, let us help them. There is nothing more comforting to humans than other humans. We have hundreds of thousands of years of evolution promoting this behavior. Trust in your desire to reach out. You and those you are helping will feel better.

And let yourself feel sad. That’s the only way to move forward.

Dr. Steve Schlozman and Dr. Gene Beresin are child and adolescent psychiatrists at Massachusetts General Hospital and are directors of the Clay Center for Young Healthy Minds: Developing Resilience through Engagement, Awareness and Media (DREAM). For more information, go to www.PathsToDream.org, and @MGHClayCenter on Twitter.

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  • Liza Knowlton Dufresne

    How about the black box warning for teens on the psych meds? Was she on psych meds?

  • Concerned Citizen

    I’m surprised to see mood disorder listed as the number one risk factor in teen suicide. What about abuse: sexual, emotional, etc., etc., from adults and peers? “Mood disorder” sounds too broad as well as euphemistic.

    It’s true, regulating your mood in your teenage years is difficult. It is even more difficult when you have poor modeling from mentally ill parents and there is no one to help you, only scold you on being a bad mood.

    There are no easy answers, and overall this is a beautifully written piece. However, I feel significant factors that contribute to suicide and thoughts of suicide have been omitted from this story.

    • KGuest

      Yes, concerned Citizen, suffering child abuse and having metal illness in the family is very painful and can contribute to depression. People who have experienced this deserve support and encouragement to get the help they need to begin healing.

      Most families do the best they can for their kids and hope that their inevitable mistakes and imperfections are overshadowed by the good they have done. Some parents pass depression on to their kids simply by having the genes for it. Sometimes forces outside the family contribute to a young person’s suffering and depression.

      Families grieving the loss of a child by suicide will naturally ask themselves how this could have happened and whether their was something they could have done differently. They, too, deserve the understanding, support, and help that they need to begin healing.

  • Anne DiNoto

    http://www.afsp.org/survivorday BU is hosting survivor day November 23 2013 Registration is open!

  • regular guy

    Its all about believe system. Here, people takes suicide as a mean to end something since they believe that death is the end of everything. Most religions see death as a phase so the believer won’t take suicide as a way to avoids or ends something. I have no religion but I too believe that there is something after death, so suicide is not in my vocabulary of action as I won’t achieve anything with it. Change the believe system about life and death, and we will see less suicides.

  • Jemimah Stambaugh

    I agree that we should feel sad: sad that that little girl will never again revel in a sunny day, an unexpected gift, the blossoming of love. It’s not just sad. It’s tragic. But I think we also need–DESPERATELY NEED–to take a look at our society. It’s one where most adults are stressed out and unhappy about their jobs. Competition is revered, and has come to thrive in a social environment where civility–forget politeness or outright friendliness–is almost nonexistent. When a grownup or parent can’t even put down their smart phone, takes antidepressants to get through everyday life and escapes through mean-spirited “sitcoms” and “reality” shows, how is the younger generation to learn about coping and about kindness? So maybe be sad for a few moments, but then how about getting angry and trying to do something to change a society where an event like this isn’t such a surprise anymore. How about paying attention–really paying attention–to the person sitting by you in class or on the T or walking by on the sidewalk: your friends and family, your neighbors, strangers. We’re all in this together…or are we?

    • GGuest

      I totally agree with you. And I applaud your naming it so well –this aspect of what has happened and is happening, with little awareness or getting at root causes and environment to stop it. Thank you for our post, and condolences to the people involved in this particular tragic loss.

    • Lisa

      agreed.

    • PattyAtkins

      my Aunty Alexandra got an almost new gold Chevrolet Camaro Z28 only from working parttime off a macbook. look at this now..ViewMore——————————————.qr.net/k0iQ

  • Mango Momma

    As long as you are dragging out statistics, how about pulling out all of them. In 1990, death by suicide peaked for the 15-24 year age group at 13.2 per 100,000 or .013%. After that, there was a drop in 2000 and since then, data shows the number hovering around 10/100000 or .010%. In the 5-14 age group, same pattern.

    I am not saying that suicide in any population is acceptable, but once again, the media is creating the impression of things spiraling out of control when that just isn’t the case.

    How about looking back at 1980 when rates peaked in the young population and figuring out if there are any similarities between then and now?

  • YesMan13

    Pushing drugs, what else is new?

    • Amy

      What article did you read? I don’t see “drugs” mentioned once in this article, nor do I infer that as the intended message. Instead, I see two professional doctors asking for education and compassion and for people to look at the topics of depression and suicide less simplistically. I also see one person who did not rise to that occasion (looking at YesMan).