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https://www.straitstimes.com/opinion/lets-talk-about-suicide-among-young-people
Ahead of World Mental Health Day on Oct 10, a psychiatrist calls for better support for young people at risk of suicide
The first time I talked to the mother of a patient who had killed himself, I was frightened.
I had had no intimation of his suicide. The patient, a young man with a serious mental illness, had been distressed over his inability to continue with his studies, but when I last saw him, about a couple of weeks before his death, he seemed to have come to terms with that, and we discussed looking for a job in the interim.
After his funeral, I'd arranged to meet his mother, who was a single parent. I was frightened because I was expecting anger and inconsolable grief, and of my own sense of helplessness that was tinged with guilt.
But when we met, there was no anger - just despairing bewilderment. A painful halting conversation followed and neither of us had any answer for the other. He'd left no suicide note, no explanation, no apology, and no farewell. I couldn't find any words to comfort her that did not sound trite and she held her palpable sadness tightly buckled up inside her.
I thought of this mother again when I read Ms Linda Collins' recently published memoir of her 17-year-old daughter, Victoria, who leaped to her death from a condominium in Singapore - something that her mother had called "this most unnatural thing" and an "act of unimaginable fear and pain and loneliness".
UNRESOLVABLE AND UNKNOWABLE
According to the World Health Organisation, suicide is the second-leading cause of death among those aged between 15 and 29. An analysis of suicides in the US by the Centres for Disease Control and Prevention showed that rates of suicide among young people jumped 56 per cent between 2007 and 2016. Last year, there were 397 suicides in Singapore, of which 94 were aged between 10 and 29.
From the moment their children are born - who they would see as a sort of facsimiles of themselves - most parents will believe in some profound inchoate way that they will know their offspring. Ms Collins' book Loss Adjustment progressively and relentlessly disabuses any parent of this notion and reveals the awful truth that there is no "safe space" within which they can shield their children from suicide, and all that love may not be defence enough to stop them from taking their life.
Her book is a grieving mother's attempt to understand and find expression for her daughter's suicide. In certain parts, it resembles a psychological autopsy, where she embarked on this quest to question her daughter's schoolmates, friends, teachers and school counsellor, and combed through Victoria's diaries and computer, where she'd kept a journal - to answer that irresistible, "Why". And that process of excavating and uncovering her daughter's hidden doubts, emerging sexuality, despair, self-cutting, and suicidal thoughts was excoriating.
There were the inevitable recriminations and guilt: "How could we have been so blind to this? Why did Victoria not tell us?… We could have saved her," wrote Ms Collins, who is a copy-editor with The Straits Times, of her much-loved daughter. She agonised about respecting Victoria's privacy and not prying into her diaries which could have alerted her to her suicidal thoughts.
However, all parents must sail between what the British psychoanalyst Rozsika Parker called "the Scylla of intrusiveness and the Charybdis of neglect", and it is only in hindsight that parents would know if they have navigated this course well enough with no calamitous mishaps.
Like so many adolescents, Victoria had contrived to maintain that outer shell to show her parents that things were fine despite that roiling inner turmoil. But she wrote in her journals about her concealed feeling of isolation, her heart-aching self-consciousness.
Adolescents are exquisitely sensitive to what other people think, and how they appear to others, all the while harbouring this terror of rejection; and they are less equipped as they have yet to accrue those experiences that would stand them in better stead to cope with life's vicissitudes.
Studies have shown that it isn't enough to simply be with people or even liked by them, we need to feel valued and have that assurance that we and what we do matter. We want approval and validation from others - something that is more acute in adolescence, that phase of life when we need to separate and individuate from our parents and form other relationships.
As they transit to adulthood, many young people might find themselves in the throes of that existential angst of trying to figure out questions like "Who am I?", "What is my purpose in life?", "What do I value?" and "What do I think others value?"
And some just can't navigate their way out of this treacherous passage in their young life to reach safer harbours - impeded and dragged down by various things to the point where death seems to be the only way out.
There are the usual suspects: some adverse childhood events like abuse, genetics, academic stress, peer pressure, overprotective and meritocratic parenting, a punishing perfectionistic trait, bullying, drug use, the pernicious influence of social media, and mental illness. And suicide is probably the consequence of some of these various factors (and perhaps others) interacting conspiratorially and lethally with each other - although in Victoria's case, she wrote in her diaries that "I have had nothing bad happen to me in my life".
In some, the intent to kill oneself would be there for some time, brewing just under the surface; while in others, the urge seems to come on quite suddenly.
A South Korean study found that almost half of patients who presented to the Emergency Departments after they tried to kill themselves, did so impulsively.
In another US study, a quarter of survivors of near-lethal suicide attempts (defined as any attempt that would have been fatal without timely medical intervention, or any attempt involving a gun) reported that they considered their actions for less than five minutes.
And even if this suicidal intent had been present for some time, many who eventually killed themselves had kept their thoughts and plans from others. And in many cases, the actual cause would forever remain unresolvable and unknowable.
Perhaps that's why the Chinese American writer Yiyun Li, whose 17-year-old son killed himself, had not tried to answer that question in the novella that she wrote after her son's death.
In her book Where Reasons End, the unnamed mother/narrator enters into an on-off conversation with the ghost of the son, Nikolai, dead at 16 by suicide.
The mother accepts his suicide as an unexplained inescapable event. "I was a generic parent grieving a generic child lost to an inexplicable tragedy... But calling Nikolai's action inexplicable was like calling a migrant bird ending on a new continent lost… Who can say the vagrant doesn't have a reason to change the course of its flight?"
And the mother wonders: "Is it a fatal condition… for some people just being themselves?"
That implied pessimistic acceptance that suicide is an appropriate or even the only option is somewhat disquieting - even nihilistic - particularly to those of us who are mental health workers.
TALKING ABOUT SUICIDE
While it is unreasonable to expect that we can prevent all suicides, it would not be unreasonable for us to strive to do that; and there are things we can do.
For one, we need to improve our ability (and willingness) to identify and support adolescents and young people at risk, and make professional help more easily available. In the course of a research project on the perception and stigma of mental illness, my colleagues and I had a series of conversations with groups of university students, and it emerged that while most are not averse to seeking psychiatric help, they don't want their parents to know about it. That, however, meant that they don't have the financial means to pay for such services.
We must explore other ways of making treatments more acceptable and accessible for young people - even allowing for the option of not informing or involving their parents; a potential path is the online delivery of interventions.
And we certainly need more local research on suicide - the findings of which would not only inform intervention and policy, but also initiate conversations about suicide at as many levels and places as possible.
Most people feel awkward talking about suicide and it is difficult to strike the right tone and in a way that will help. There is that common notion that, if you ask someone about thoughts of suicide, you might actually plant that idea in their head; but done right, it is more likely that they will feel relieved to be able to open up and talk about it, and that might pull them back from that cliff edge of self-extinction.
Ms Collins' sorrowing chronicle should make all parents realise that they need to talk to their children about suicide, even though that in itself is no guarantee of prevention. And yes, it is tough to do so, and the Society for the Prevention of Teen Suicide (a non-profit organisation founded in 2005 in the US by two friends who lost teenage children to suicide) advises parents to openly acknowledge this discomfort as that would also give the child permission to acknowledge his/her discomfort as well. It also advises parents to prepare ahead on what they would want to say, not to overreact (which would shut off the child), and to pick the right time to have that talk, such as in the wake of a media report of a suicide.
The theme for this year's World Mental Health Day on Oct 10 is suicide prevention, and it might also be a good time to have that talk.
• Professor Chong Siow Ann, a psychiatrist, is vice-chairman of the medical board (research) at the Institute of Mental Health.
Ahead of World Mental Health Day on Oct 10, a psychiatrist calls for better support for young people at risk of suicide
The first time I talked to the mother of a patient who had killed himself, I was frightened.
I had had no intimation of his suicide. The patient, a young man with a serious mental illness, had been distressed over his inability to continue with his studies, but when I last saw him, about a couple of weeks before his death, he seemed to have come to terms with that, and we discussed looking for a job in the interim.
After his funeral, I'd arranged to meet his mother, who was a single parent. I was frightened because I was expecting anger and inconsolable grief, and of my own sense of helplessness that was tinged with guilt.
But when we met, there was no anger - just despairing bewilderment. A painful halting conversation followed and neither of us had any answer for the other. He'd left no suicide note, no explanation, no apology, and no farewell. I couldn't find any words to comfort her that did not sound trite and she held her palpable sadness tightly buckled up inside her.
I thought of this mother again when I read Ms Linda Collins' recently published memoir of her 17-year-old daughter, Victoria, who leaped to her death from a condominium in Singapore - something that her mother had called "this most unnatural thing" and an "act of unimaginable fear and pain and loneliness".
UNRESOLVABLE AND UNKNOWABLE
According to the World Health Organisation, suicide is the second-leading cause of death among those aged between 15 and 29. An analysis of suicides in the US by the Centres for Disease Control and Prevention showed that rates of suicide among young people jumped 56 per cent between 2007 and 2016. Last year, there were 397 suicides in Singapore, of which 94 were aged between 10 and 29.
From the moment their children are born - who they would see as a sort of facsimiles of themselves - most parents will believe in some profound inchoate way that they will know their offspring. Ms Collins' book Loss Adjustment progressively and relentlessly disabuses any parent of this notion and reveals the awful truth that there is no "safe space" within which they can shield their children from suicide, and all that love may not be defence enough to stop them from taking their life.
Her book is a grieving mother's attempt to understand and find expression for her daughter's suicide. In certain parts, it resembles a psychological autopsy, where she embarked on this quest to question her daughter's schoolmates, friends, teachers and school counsellor, and combed through Victoria's diaries and computer, where she'd kept a journal - to answer that irresistible, "Why". And that process of excavating and uncovering her daughter's hidden doubts, emerging sexuality, despair, self-cutting, and suicidal thoughts was excoriating.
There were the inevitable recriminations and guilt: "How could we have been so blind to this? Why did Victoria not tell us?… We could have saved her," wrote Ms Collins, who is a copy-editor with The Straits Times, of her much-loved daughter. She agonised about respecting Victoria's privacy and not prying into her diaries which could have alerted her to her suicidal thoughts.
However, all parents must sail between what the British psychoanalyst Rozsika Parker called "the Scylla of intrusiveness and the Charybdis of neglect", and it is only in hindsight that parents would know if they have navigated this course well enough with no calamitous mishaps.
Like so many adolescents, Victoria had contrived to maintain that outer shell to show her parents that things were fine despite that roiling inner turmoil. But she wrote in her journals about her concealed feeling of isolation, her heart-aching self-consciousness.
Adolescents are exquisitely sensitive to what other people think, and how they appear to others, all the while harbouring this terror of rejection; and they are less equipped as they have yet to accrue those experiences that would stand them in better stead to cope with life's vicissitudes.
Studies have shown that it isn't enough to simply be with people or even liked by them, we need to feel valued and have that assurance that we and what we do matter. We want approval and validation from others - something that is more acute in adolescence, that phase of life when we need to separate and individuate from our parents and form other relationships.
As they transit to adulthood, many young people might find themselves in the throes of that existential angst of trying to figure out questions like "Who am I?", "What is my purpose in life?", "What do I value?" and "What do I think others value?"
And some just can't navigate their way out of this treacherous passage in their young life to reach safer harbours - impeded and dragged down by various things to the point where death seems to be the only way out.
There are the usual suspects: some adverse childhood events like abuse, genetics, academic stress, peer pressure, overprotective and meritocratic parenting, a punishing perfectionistic trait, bullying, drug use, the pernicious influence of social media, and mental illness. And suicide is probably the consequence of some of these various factors (and perhaps others) interacting conspiratorially and lethally with each other - although in Victoria's case, she wrote in her diaries that "I have had nothing bad happen to me in my life".
In some, the intent to kill oneself would be there for some time, brewing just under the surface; while in others, the urge seems to come on quite suddenly.
A South Korean study found that almost half of patients who presented to the Emergency Departments after they tried to kill themselves, did so impulsively.
In another US study, a quarter of survivors of near-lethal suicide attempts (defined as any attempt that would have been fatal without timely medical intervention, or any attempt involving a gun) reported that they considered their actions for less than five minutes.
And even if this suicidal intent had been present for some time, many who eventually killed themselves had kept their thoughts and plans from others. And in many cases, the actual cause would forever remain unresolvable and unknowable.
Perhaps that's why the Chinese American writer Yiyun Li, whose 17-year-old son killed himself, had not tried to answer that question in the novella that she wrote after her son's death.
In her book Where Reasons End, the unnamed mother/narrator enters into an on-off conversation with the ghost of the son, Nikolai, dead at 16 by suicide.
The mother accepts his suicide as an unexplained inescapable event. "I was a generic parent grieving a generic child lost to an inexplicable tragedy... But calling Nikolai's action inexplicable was like calling a migrant bird ending on a new continent lost… Who can say the vagrant doesn't have a reason to change the course of its flight?"
And the mother wonders: "Is it a fatal condition… for some people just being themselves?"
That implied pessimistic acceptance that suicide is an appropriate or even the only option is somewhat disquieting - even nihilistic - particularly to those of us who are mental health workers.
TALKING ABOUT SUICIDE
While it is unreasonable to expect that we can prevent all suicides, it would not be unreasonable for us to strive to do that; and there are things we can do.
For one, we need to improve our ability (and willingness) to identify and support adolescents and young people at risk, and make professional help more easily available. In the course of a research project on the perception and stigma of mental illness, my colleagues and I had a series of conversations with groups of university students, and it emerged that while most are not averse to seeking psychiatric help, they don't want their parents to know about it. That, however, meant that they don't have the financial means to pay for such services.
We must explore other ways of making treatments more acceptable and accessible for young people - even allowing for the option of not informing or involving their parents; a potential path is the online delivery of interventions.
And we certainly need more local research on suicide - the findings of which would not only inform intervention and policy, but also initiate conversations about suicide at as many levels and places as possible.
Most people feel awkward talking about suicide and it is difficult to strike the right tone and in a way that will help. There is that common notion that, if you ask someone about thoughts of suicide, you might actually plant that idea in their head; but done right, it is more likely that they will feel relieved to be able to open up and talk about it, and that might pull them back from that cliff edge of self-extinction.
Ms Collins' sorrowing chronicle should make all parents realise that they need to talk to their children about suicide, even though that in itself is no guarantee of prevention. And yes, it is tough to do so, and the Society for the Prevention of Teen Suicide (a non-profit organisation founded in 2005 in the US by two friends who lost teenage children to suicide) advises parents to openly acknowledge this discomfort as that would also give the child permission to acknowledge his/her discomfort as well. It also advises parents to prepare ahead on what they would want to say, not to overreact (which would shut off the child), and to pick the right time to have that talk, such as in the wake of a media report of a suicide.
The theme for this year's World Mental Health Day on Oct 10 is suicide prevention, and it might also be a good time to have that talk.
• Professor Chong Siow Ann, a psychiatrist, is vice-chairman of the medical board (research) at the Institute of Mental Health.
Look at John, he's our shining example of happiness!
But Knn, if we believe too much of what we are saying, we could jolly well become permanent pap supporters!
