The Shallows: The Tragedy of Youth Suicide

Youth mental health and suicide in America.

Posted Aug 15, 2019

Dan Convey on Unsplash
Source: Dan Convey on Unsplash

The recent death of Saoirse Kennedy Hill at the family compound in Hyannis Port, Massachusetts, lays bare—in painful ways—the mental health crisis gripping America. Ms. Kennedy Hill, much to her credit, shared openly her struggles with depression and suicidal intent in a February 2016 opinion piece for her boarding school paper, The Deerfield Scroll. She wrote, “My depression took root in the beginning of my middle school years and will be with me for the rest of my life. Although I was mostly a happy child, I suffered bouts of deep sadness that felt like a heavy boulder on my chest” (Kennedy Hill, 2016).

Ms. Kennedy Hill’s story, while enormously tragic, is frighteningly familiar. Indeed, in adolescence, naturally occurring changes in neurochemistry presage noticeable shifts in emotion including everything from irritability to melancholy—and things more serious such as anxiety, depression, and thoughts of self-harm.

The National Alliance on Mental Illness reports, “Mental health conditions are common among teens and young adults. One in five live with a mental health condition—half develop the condition by age 14 and three quarters by age 24” (NAMI, 2019). Additionally, a Vox article published last month noted the precipitous rise in mood disorders and suicides among this cohort. Citing data from the Centers for Disease Control and Prevention (CDC), it stated, “after a steep drop in the late 1990s, the number of suicide deaths among young people… began climbing around 2008 before reaching a new high in 2017” (Resnick, 2019).

What do those numbers look like? The Jason Foundation (JFI), a nonprofit dedicated to the prevention of suicide (the “silent epidemic”), notes that it is the second-leading cause of death for those ages 10-24—more “than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, combined” (JFI, 2019).

This conundrum of suicide requires the commitment of all who care for young people to take a deeper dive into a very necessary conversation about the tidal wave of self-harm that not only ends lives but also can cripple those left behind.

JFI, a collaborator at the Center for Adolescent Research and Education (CARE), works to raise awareness of the problem through education while providing key stakeholders with the tools and help they need to both identify and take care of youth at risk.  

Which begs the question, “Who is at risk?” Sadly, most anybody.

As Deborah Serani wrote in the June 2019 edition of The Sober World magazine, “Depression cuts across socioeconomic status, is found in every culture and in every country around the world” (Serani, 2019).

That having been said, there are subsets of teens who appear to be more at risk than others. According to the Child Mind Institute, they correlate with the following risk factors (Kaslow, 2019).

  • A recent or serious loss
  • A psychiatric disorder, particularly a mood disorder like depression, or a trauma-  and stress-related disorder
  • Prior suicide attempts
  • Alcohol or other substance use disorders
  • Struggling with sexual orientation in an environment that is not respectful or accepting of that orientation
  • A family history of suicide, domestic violence, child abuse or neglect
  • Lack of social support
  • Bullying
  • Access to lethal means, such as firearms and pills
  • Stigma associated with asking for help
  • Barriers to accessing services
  • Cultural and religious beliefs that suicide is a noble way to resolve a personal dilemma

Some good news can be found in the fact that where risk factors exist, there also reside protective factors.

The Suicide Prevention Resource Center says, “Protective factors are personal or environmental characteristics that help protect people from suicide.” Those factors include the following (SPRC, 2019).

  • Effective behavioral health care
  • Connectedness to individuals, family, community, and social institutions
  • Life skills (including problem-solving skills and coping skills, ability to adapt to change)
  • Self-esteem and a sense of purpose or meaning in life
  • Cultural, religious, or personal beliefs that discourage suicide

What else do we need to know?

Ross Szabo, award-winning speaker and author of “Behind Happy Faces,” says, “One of the largest gaps in our country right now is not having enough mental health curriculums to teach people of all ages the skills they need to manage their mental health. Now it’s time to take the next step and help people develop skills to address their emotions. Our country teaches about physical health and diet from kindergarten through the rest of a person’s life. It’s time to do the same with mental health!” (Szabo, 2019).

In a February 2018 presentation at the annual conference of the American Camp Association, Szabo advocated for blending social-emotional learning with neuroscience, psychology, physiology, and mindfulness. He also warned that suicide can be impulsive, so awareness and prevention efforts should not be static but rather ongoing and fluid.

For its part, Florida recently mandated that public schools teach students at least five hours of mental health curriculum beginning in the sixth grade. State education commissioner Richard Corcoran explained that the new directive “will require students to take courses aimed at helping them to identify the signs and symptoms of mental illness, find resources if they are battling with depression or other issues, and teach them how to help peers who are struggling with a mental health disorder.

“We are going to reinvent school-based mental-health awareness in Florida, and we will be the number one state in the nation in terms of mental health outreach and school safety …” (Ceballos, 2019).

Others, such as Jason Reid, founder of Chooselife.org and a member of the National Advisory Board at CARE, also believes that, in America, we need to go beyond awareness to end the epidemic. Reid, who lost a 14-year-old son to suicide, established an “immense goal” of eliminating such deaths by 2030.

How to get there? Reid suggests a collaborative approach involving five pillars to support improving mental health among youth: parents, schools and government, children, the medical community and social media.

Of course, this type of game plan assumes that the people in a young person’s life have the information they need to help. In Ms. Kennedy Hill’s telling, that didn’t seem to be the case for her. She explained, “Although my friends were extremely supportive, they seemed to be the only ones who knew what had been going on in my life for the past year.” Ms. Kennedy Hill pointed out that HIPAA privacy provisions left her feeling very much alone and unable to share her pain with important people at Deerfield, including teachers and advisors.

Ms. Kennedy Hill also addressed the stigma issue, stating, “Deerfield is one of the top educational institutions in the country, yet no one seems to know how to talk about mental illness. People talk about cancer freely; why is it so difficult to discuss the effects of depression, bi-polar, anxiety, or schizophrenic disorders? Just because the illness may not be outwardly visible doesn’t mean the person suffering from it isn’t struggling.”

But the stigma tide may be turning.

According to the American Psychological Association, young people ages 15-21 “are more likely (37 percent), along with millennials (35 percent), to report they have received treatment or therapy from a mental health professional, compared with 26 percent of Gen Xers, 22 percent of baby boomers and 15 percent of older adults” (Bethune, 2019).

That’s good news. But any comprehensive plan to address the growing scourge of suicides among young people must necessarily address how they speak to themselves and how readily they can share their feelings with others.

Somewhat reminiscent of cognitive-behavioral forms of therapy, this approach seeks to shrink—or largely ameliorate—the gap between what psychologist Carl Rogers referred to as the real (or actual) self versus the ideal self or, more recently, what Mary Pipher, co-author of Reviving Ophelia—Saving the Selves of Adolescent Girls, terms authentic versus false self. Pipher highlights the rapid rise in depression and suicides among girls, something noted in last May’s TIME magazine article “The Gap Between Male and Female Youth Suicide Rates Is Narrowing in the U.S.” (Ducharme, 2019).

A March 2018 article, “All This Darkness Past,” shared the story of Madison Holleran, a University of Pennsylvania student who took her life by jumping from the roof of a campus parking garage. It stated, “The loss of Madison, a rising track star and a young woman who to most seemed to, proverbially, ‘have it all,’ gave notoriety to the term ‘Penn Face,’ which reflects the pressure students feel to ‘be normal’ and to fit in. Penn Face and similar monikers at other schools belie the façade many young people present to others, including those closest, in order to look strong, self-assured and successful” (Wallace, 2018).

In other words, a false self—perpetuated by what Zen Buddhists refer to as “Monkey Mind,” or constant inner chatter “that negatively affects our mood—making us unhappy angry, restless and anxious,” increases the likelihood of self-harm (Fabrega, 2019).

Adding her personal story to the struggles of so many, 16-year-old Ellie Russo told me in an email, “We all have a little voice inside our heads. That voice can be supportive, hurtful, or an internal version of the peanut gallery. Whatever that voice is, it tells you what to do, when to do it, and how to go about it. My voice used to be very bad. It used to fill me with negative and depressing thoughts. It would tell me that I was not good enough or that I didn’t have what it took. As much as I tried to ignore it, it wouldn’t go away. It conjured up awful scenarios that could not possibly happen, but that still terrified me.

“My voice wanted me to fit in. I felt that in my community, it was the only thing that mattered. From the moment that I walked into school on my first day of kindergarten, I took note of what everyone was wearing. What was ‘cool’? What was ‘ugly’? What was ‘acceptable’? Eventually, this little voice completely consumed me. I was severely depressed and anxious so I sought out help, not to get rid of the voice, but to turn it into a positive one that could be my personal cheerleader. I am fortunate to have realized at an early age that there is extreme value in understanding that we are so much more than the little voice inside of us telling us what’s wrong.”

The work of important youth influencers identified by CARE as peers, parents, teachers/professors, coaches, camp counselors, physicians, mental health professionals and faith-based mentors, along with courageous people like Ms. Kennedy Hill and Ms. Russo, can go a long way toward accentuating what is right and rescuing those on the shoals and in the shallows of life.

References

Bethune, S. (2019). Gen Z more likely to report mental health concerns. Monitor on Psychology. January 2019. American Psychology Association. https://www.apa.org/monitor/2019/01/gen-Z (12 Aug. 2019).

Ceballos, A. (2019). Florida makes mental health classes mandatory in public schools starting in the 6th grade. WPTV: West Palm Beach 5. July 18, 2019. https://www.wptv.com/news/state/florida-makes-mental-health-classes-mandatory-in-public-schools-starting-in-the-6th-grade (12 Aug. 2019).

Ducharme, J. (2019). The gap between male and female youth suicide rates is narrowing in the U.S. May 17, 2019. TIME. https://time.com/5590344/youth-suicide-rates/ (12 Aug. 2019).

Fabrega, M. (2019). 10 ways to tame your monkey mind and stop mental chatter. Daringtolivefully.com. https://daringtolivefully.com/tame-your-monkey-mind (12 Aug. 2019).

JFI. (2019). Youth suicide statistics. The Parent Resource Program. The Jason Foundation. http://prp.jasonfoundation.com/facts/youth-suicide-statistics/ (12 Aug. 2019).

Kaslow, N. (2019). Teen suicides: what are the risk factors?. Child Mind Institute. https://childmind.org/article/teen-suicides-risk-factors/ (12 Aug. 2019).

Kennedy Hill, S. (2016). Mental illness at Deerfield. The Deerfield Scroll. February 3, 2016. http://deerfieldscroll.com/2016/02/mental-illness-at-deerfield/ (12 Aug. 2019).

NAMI. (2019). Teens and young adults. National Alliance on Mental Illness. https://www.nami.org/Find-Support/Teens-and-Young-Adults (12 Aug. 2019).

Pipher, M. and S. Pipher Gilliam. (2019). Reviving Ophelia: Saving the selves of adolescent girls. New York: Riverhead Books. 2019.

Reid, J. (2019). The mission. Chooselife.org. https://www.chooselife.org/ (12 Aug. 2019).

Resnick, B. (2019). Teens are increasingly depressed, anxious and suicidal. How can we help? Vox Media. July 11, 2019. https://www.vox.com/science-and-health/2019/7/11/18759712/teen-suicide-depression-anxiety-how-to-help-resources (12 Aug. 2019).

Rogers, C. R. (1959). A Theory of Therapy, Personality, and Interpersonal Relationships: As Developed in the Client-Centered Framework. In S. Koch (Ed.), Psychology: A Study of a Science. Formulations of the Person and the Social Context (Vol. 3, pp. 184-256). New York: McGraw Hill.

Serani, D. (2019). Sobriety, depression and suicide. The Sober World. June 30, 2019. https://www.thesoberworld.com/2019/06/30/sobriety-depression-and-suicide/ (12 Aug. 2019).

SPRC. (2019). Risk and protective factors. Suicide Resource Prevention Center. https://www.sprc.org/about-suicide/risk-protective-factors (12 Aug. 2019).

Szabo, R. (2019). Behind happy faces. Curriculum. http://rossszabo.com/curriculum/ (12 Aug. 2019).

Wallace, S. (2018). All this darkness past. LinkedIn. March 15, 2018. https://www.linkedin.com/pulse/all-darkness-past-stephen-gray-wallace-1/?published=t (12 Aug. 2019).