Children and Suicide in Today’s World
The topic of suicide and children is one that has been approached with great difficulty. All too often parents, educators, therapists, and other caring professionals are unwilling or unable to speak of the issues surrounding suicide with today’s youth. Yet in our nation and in our world the young people globally are inundated and overwhelmed directly and vicariously with issues of suicide. The media acting as a surrogate parent, extended family, and ongoing source of amusement and stimulation creates graphic accounts for all kids to witness and potential glorify and imitate. Suicide/murder rampages in our schools, suicide/murder devastations within family systems and terrorist suicide/murder traumas within our communities are relived over and over again in the name of news.
Children as survivors of suicide are becoming an increasingly larger population. Thousands of children a year will have a parent die of suicide, with hundreds of thousands of others living with friends or family members suffering from depression and suicidal thoughts. Suicide has become the second leading cause of death with young people in the United States today, with one young person every 90 minutes dying of suicide. Children at younger and younger ages are living with suicidal ideation, attempts, and dying of suicide. Ten percent of high school teens polled in 1999 in Washington DC stated they had attempted suicide within the past year.
The Silence of Suicide
Yet our society so often sends out a message that children are too young to talk about suicide. A first grade teacher dies of suicide and the school requested help with the children. “Linda, please help us talk with the children about death. We’ve decided not to tell the children about the suicide.” I find my hands are tied and I must persist in emphasizing that without telling the children the truth, they cannot fully grieve the death of their teacher. Similarly, in another case a twelve-year-old Thomas hung himself on the playground after school. The next morning the tree where he hung himself was cut down. This school system never mentioned to any of the students the way Thomas died.
When Ellen was six her mom died of suicide, but just before being sent off to camp she was told that Mom died. At age twenty, Ellen learned Mom had died of suicide. Devastated and shocked, Ellen spent much of her adult years feeling angry, frustrated, and cheated. Not only did she grieve the death of her mom, the way mom died, but the loss of the trust of her emotional environment for so much of her childhood. “It wasn’t my mother’s irrational act that was so upsetting,” Ellen explained, “but the way the adults around me handled that act!”
Talk to Kids about Suicide
Counselors, therapists, educators, parents, and other caring professionals must explore the topic of suicide openly with children if we are to break through the barriers of shame and secrecy that accompany this topic, and create fertile ground for the resolution of this complicated grief situation. It is natural for children to grieve the death of someone who is a significant person in their lives. Yet, suicide creates a set of traumatic emotional issues that tend to separate the child from the natural flow of grief. So often a child can not say that their special person died because they would have to say how that person died. These unexpressed and unresolved life issues, these frozen blocks of time, create a wall of ice between the child and his or her grief and it is up to us as caring adults to help melt down that wall.
Caring adults need to achieve openness about this previously closed topic of suicide by:
1. Stressing the underlying belief that we always need to separate the person who died from the way that person died to truly grieve the person’s death.
2. Defining suicide to children in simple and direct language that eliminates judgment.
Suicide and the Surviving Parent or Guardian
Seven-year-old Mary’s mom had died of suicide and her dad, Mark, could not bring himself to tell her the truth. It is essential to work with the surviving parent or guardian and provide a model of language to use with suicide and reduce current fear levels. Role plays involving role reversals with parent and therapist begin to create a comfort zone.
Mary had been fighting with kids in school, especially when they would ask her how her mom died. She was told Mom had died of a stroke. Somewhere kids sense they are being lied to, and uncertainty and potential rage become an all pervasive part of their life.
The terror of telling his daughter and the overwhelming shame of his wife’s suicide had silenced his voice. Mark decided to put his explanation in writing. It was a first step to safeguarding his truth, externalizing his secret, and creating the possibility of talking to Mary about Mom’s death. Mark talked about suicide in the letter to Mary by:
Defining suicide. That means “she decided to make her body stop working.” Mom was having problems keeping her thinking straight. She would get depressed and scared way beyond the normal way we all sometimes get depressed and scared. She went to a doctor, but he wasn’t able to help her very much. The more depressed and scared she got, the more mixed up her thinking became. She was not able to organize her life, she would just not show up at work, she would do strange things like yell at the mailman one day and then the next day forget she ever did that.”
Telling age appropriate facts about what happened. “One day Mom took a whole bottle of sleeping pills. It made her body stop working. We don’t know if she was confused and only meant to take 1 or 2 pills or if she meant to take them all, knowing that it could make her body stop working and die.”
Retelling good memories. “When Mom wasn’t feeling mixed up, she would like to be with you. She would read to you, sing to you, and love to rock you in her arms. She talked a lot about how much she loved you and how scared she was that she was not a good enough mother.”
Dispelling myths of suicide. “We don’t know all the reasons some people do this. Sometimes kids may worry that if a parent decides to end their own life, they might too. Suicide is not catching, like a cold. It is not hereditary or genetic, like having blue eyes. Mom’s depression and decision not to live belonged to her. You are separate and in no way caused or created it.”
Modeling feelings and thoughts. “Sometimes I wish Mom would have realized how much we would miss her because we loved her so much. And she would have looked harder for another way if only to not cause us so much sadness and pain. It makes me very angry because I miss her so very much.”
Providing alternatives. “Mary, Mommy made a very big mistake. She felt ending her own life was the solution to her problems. Nobody knows what the right solution might have been, but we would have continued to help her look for it if she would have just given us more time. There’s always another way.”
Suicide and Shame and Stigma
Kelly was a fifth grader whose dad died of suicide on her birthday just before her summer vacation. She spent the summer alone, angry, and ashamed. When Kelly began a new school in the fall I asked her if she had called any of her old friends. “No” she explained, “I didn’t because if I called them I would have to tell them that my dad died and then I would have to tell them how my dad died. Remaining ashamed and silent, Kelly experienced not only the death of her dad, the shame and stigma around the way her dad died, but the secondary loss of friendships as well.
Suicide and Loss of Trust of the Emotional Environment
Kelly experienced yet another loss after her dad’s suicide, the loss of the trust of her emotional environment. Soon after dad’s death Kelly began feeling Mom was always “on her case”, fearful of drug use, promiscuity, and failing grades. Six months later Mom shared a deep secret, she was left the following note by her husband. “It is your fault I am killing myself. Please do not tell Kelly how I died. And remember to keep an eye on her because you know suicide runs in our family”. Only after she could speak of this note could she begin to acknowledge the overwhelming terror of the prophecy that suicide could happen to her daughter too.
Magical Thinking, Guilt, and Over-Responsibility
Jane was a ten-year old who’s Mom had died of suicide by shooting her- self in the head in the closet of her bedroom while Jane was watching TV. Jane told her counselor at school that she was happy her mom killed herself. She explained “My mom wanted to kill herself and if she is happy, I am happy”. Jane’s mom had suffered with depression for many years, and Jane had explained to her counselor that “it was my job to make my mom happy and I could never do it right”. Kids and adults often feel an over responsibility, guilt, and magical thinking that they could have saved this person. Sometimes with difficult relationship, children may feel a conscious or unconscious sense of relief that they no longer have the impossible task of making that person happy and well.
Suicide and Manipulation
A teacher in one of my trainings asked advice for the following problem. She explained that 10-year-old Mary was being so manipulative. Her dad died of suicide and she kept talking about him and the way he died to her friends and teachers at school. How could they stop this manipulative behavior?” This teacher failed to realize a basic understanding of children, grief, and trauma – children need to tell their story over and over again.
Eleven-year-old Kevin said he wanted to jump off the roof and kill himself. His school principal said he was just being manipulative and expelled him from school. “Suicide could be the ultimate manipulation.” I explained. “Would you want that on your hands?” He began the process of seeking professional help for Kevin. We need to educate all caring professionals and children that any threat of harm to oneself should be taken seriously.
Many times children struggle with difficult feelings as a suicide survivor. Often grieving children stress feelings of not wanting to seem different than other children. Sometimes children try to normalize very traumatic circumstances. One fourteen-year-old girl attempted to normalize the death of a loved one by suicide by creating her own definition of suicide. She explained the way she saw suicide was that “ever one who has died, except for elder’s, committed suicide” and gave examples of her thinking including heart attack (overweight and smoking; did nothing about it), hit by a car (didn’t look before crossing street), murdered (was probably involved with killer), and cancer – (smoking, never quit). She states, “Everyone does it sooner or later. Hurts themselves out of carelessness (Goldman, Breaking the Silence, 2001)”.
Suicidal Thoughts and Feelings in Children
Children can experience depression and not have the language or the emotional support to process difficult feelings. These thoughts and feelings remain hidden, with no outlet, and the young child may begin a process of disconnection that can emerge in teen years as suicidal or homicidal ideation, depression or violence and crime. The following drawing illustrates the emotional pain a child felt after experiencing the sudden death of his older sister Meredith. Alex was seven when Meredith overdosed on drugs. He describes the picture as follows:
“This is me and this is my soul. My pain is in the center of my soul. It’s kind of like a disease. Sometimes I feel like killing myself so I’ll disappear and not have pain (Goldman, Breaking the Silence, 2001)”.
Alex’s drawing showed a child smiling behind masked feelings of despair, common among young children. His soul is separate from his body, illustrating the beginning of an archetype of a segment of today’s youth. Many of our teens become disconnected from their hearts, minds, and consciousness, eventually choosing drugs, crime, and violence as viable alternatives.
Depression in young children may appear as false smiles, hyperactivity, inability to concentrate, bullying, withdrawal, or isolation. As difficult as it is for parents and professionals to see and hear Alex’s feelings of agony, we can only imagine how much harder it would be for this child to live with these feelings in silence.
Recommendations for Caring Adults
1. Talk to children about suicide.
– Define suicide as when “someone chooses to make their body stop working.”
– Give age-appropriate facts and explanations.
– Dispel myths of suicide.
– Retell good memories.
– Model feelings and thoughts for children.
– Emphasize suicide is a mistake because there “is always another way out.”
2. Recognize signs of complicated grief issues in children
* Outbursts of aggressiveness or withdrawal
* Extreme feelings of unworthiness or powerfulness
*Nightmares, bedwetting, regressive behaviors
*Conflicted relationship with person that died
*Withdrawal from school and social activities
*Extreme guilt and over responsibility about the person that died
*Hyperactivity, impulsivity, and inability to concentrate
*Giving away possessions and planning their own funeral
3. Screen for at risk children.
Caring professionals need to be vigilant in screening for at-risk children, beginning in the elementary school. Child survivors of suicide may be at-risk depressed children. Depressed children respond consistently to these questions:
Do you feel sad all of the time?
Do you feel hopeless all of the time?
As a simple at-risk screening tool, ask young children to write or draw:
What makes you the angriest? What scares you the most?
What makes you very sad? What do you wish for the most?
4. Provide tools to help children recognize their support system. Create an assignment with children called “The Circle of Trust”. Children place their picture or name in the center of concentric circles, then place people they trust the most in the next circle with phone numbers, people they trust next in next circle, and people they don’t trust outside the circles. This tool can be used preventatively for children to increase awareness of their safe support system.
5. Use projective techniques with children. Storytelling, drawing, puppets, clay figures, sand table figures, punching bags and foam bats and balls are extremely effective ways of working through difficult thoughts and feelings. Often children can not or will not verbalize their feelings directly, and need outlets for feelings of self hatred, guilt, and self destruction. Without appropriate role models, the emotional environment can reinforce silence. Children may be terrified of telling some deep family secret because of shame or personal threats. Projective techniques can often open the locked doors to children’s underlying and hidden grief.
Activities to Use with Children and Suicide
* Make a memory book about the person who died. Remind the child that the suicide was not the child’s fault. Include the following:
“Why did you kill yourself? or
“I feel ________ about how you died.”
“If I could do one thing over, what would it be?”
*Make a collage with magazines and newspapers of ways to work through painful and overwhelming feelings safely.
*Use third person language because it’s less threatening to kids. “Many people feel suicide is… “This enables children to open up more easily.
*Write a letter to the person who has died of suicide, expressing feelings about that person and about how that person died.
*Provide a “worry box” where children can place written or drawn worries about suicide.
*Use activities involving writing, drawing, or talking about secrets
“Secret Witchy” is a stuffed toy with an opening in her mouth in which kids can put their secrets.
Secret marker hides writing until rewritten with encoding marker.
Lemon juice with a paint brush hides secret until message put under light.
Tape recorder talk is a time when children can whisper their secrets into a tape recorder and play it back only if they choose to share them.
Computers for storytelling and writing secrets. Children can create a secret file and share if they choose. Remind children they can share their secrets only if they wish, and that some secrets are for sharing.
(Adapted from Breaking the Silence, 2001)
Words to Use with Children and Suicide
Death: Death is when a person’s body stops working
Depression: Extreme feelings of sadness and hopelessness that last a long time.
Guilt: A feeling that makes someone think they are the cause of something and they may have done something wrong.
Grief: The natural feelings people feel after someone close to them has died. They can be feelings of sadness, anger, fright, or guilt.
Suicide: The act of killing yourself so that your body won’t work anymore. People may do this when they feel there is no other way they can think of to solve their problems – that there is no other way they can think of to escape their pain, or they may feel at the moment that life is not worth living. People can get help. (Goldman, Breaking the Silence, 2001)
Our inability to discuss the topic of suicide openly with children can create an atmosphere of fear, isolation and loneliness that can be far more devastating than the death of a loved one. As grief therapists, counselors, and educators we need to create and model ways to discuss suicide with children through the use of age-appropriate language, teachable moments, and non-judgmental values.
When suicide/murder rampages such as the tragedy at Columbine High are broadcast by the media for our school-age children to witness repeatedly, we can create a “teachable moment” of dialogue about the subject of suicide, present viable alternatives and policies to bullying and victimization, and provide safe ways to work through dangerous and scary feelings in our classrooms, homes, and communities.
Caring adults must provide models of constructive ways to cope with depression, and procedures in school and at home to deal with someone close to them who may be thinking or acting as if they wanted to harm themselves. Trainings for children, therapists and educators on suicide awareness, targeting signs of depression in children and adolescents and ways to work with them, and open and honest dialogue about difficult subjects can ease the way to a natural grief process by eliminating so much of the guilt, shame, and silence surrounding today’s youth and suicide.
A useful paradigm for working with kids and suicide is remembering “What is mentionable is manageable.” Helping children define suicide, giving age-appropriate explanations, remember in a good and difficult memories about the loved one, sharing real life events about their depression, and listening without judgment about issues involving suicide can begin to free the natural flow of grief feelings all too often blocked when a suicide occurs.