High School and College Suicide: What Lies Beneath

Students at Claremont McKenna mourn two suicides in a week

If you have been touched by suicide and are feeling alone, you might find this Twitter based community heartbreaking, heart wrenching and comforting.

I live in Los Angeles and like most people nothing breaks through my “out of sight, out of mind” ability to insulate myself from feeling traumatized by tragedy more than when it happens in my own backyard.

And that is what just happened with the two recent suicides within the same week at Claremont McKenna College.

What causes so many young students with so much life ahead of them to kill themselves?

And why do others who after the tragic events and who coulda, shoulda but didn’t do anything not do anything?

That is what we’ll try to address.

First of all, who am I?

I am a retired psychiatrist who for close to thirty years was a “boots on the ground” specialist in suicide prevention and intervention. Professors, universities and other practicing psychiatrists would refer me their highly suicidal patients because I had a good track record (nobody killed themselves while I was treating them).

It seems like yesterday instead of more than thirty years ago when I was a guest lecturer at UCLA in a popular course on death and suicide.

Dr. Mark Goulston speaking at UCLA in 1990’s in Death and Suicide Course

As we review the too frequent news about these tragic suicides the apparent causes seem fairly predictable. Too much pressure from the outside, too much self-inflicted pressure from the inside, the loss of a love relationship, increasing isolation, the slippery slope of drug — especially opiate — abuse to ease the pain of it all or just to escape, etc. Or it’s the failure of the system to not address it, not necessarily because it doesn’t want to, but more often because it doesn’t know how to in a way that prevents deathfulness.

There are more than enough articles, books, research focusing on all of these factors that you can readily find on the Internet not to mention great resources including:

· AFSP (American Foundation for Suicide Prevention) vhu

· IASP (International Association for Suicide Prevention)

· JED Foundation

· NAMI National Alliance on Mental Illness

· American Association of Suicidology

· Suicide Prevention Resource Center

· Kevin and Margaret Hines Foundation

· Didi Hirsch Suicide Prevention

My approach will be to describe and explain from my clinical experience and empirical non-evidence based observations how the journey from birth to des-pair (in the end being unpaired with the reasons to live and replacing them with hopelessness, helplessness, powerlessness, worthlessness, uselessness, meaninglessness and finally pointlessness that results in pairing with death to take the pain away) takes place.

Although far too many babies are born with bad genes and into a socially horrendous situation (although in the latter, survival often simplifies life and prevents suicidality, because their mind is focused on merely surviving) that can contribute to anxiety, depression and suicide later in life, our focus will charting how people psychologically develop these conditions.

For the purpose of this composition, let’s imagine a truth that happens with all newborns in that they are born helpless, powerless, dependent and completely vulnerable.

Beyond food and protective clothing, etc. Erik Erikson explained in his eight stages of psychosocial development that the caretakers around us can cause us to step into life feeling basis trust or basic mistrust.

Excess abuse or neglect or even excess coddling (which causes a very rude awakening when you step into the real world later in life) can send us into the world distrustful, feeling overly vulnerable after being immersed in those detrimental interactions. When that happens, we step into life with our guards up, believing, that additional trauma will destroy us. And then we spend too much time looking where we are going filled with caution, anxietyand sometimes even paranoia at a young age.

When we go through life on a foundation of basic mistrust, having experienced primal vulnerability as the first shoe falling, we are increasingly vigilant and on the lookout for that traumatic second shoe that we are almost certain will do us in.

If on the other hand as an infant and child we received accurately attuned parenting that instead of abusing, neglecting or coddling poured mentoring, coaching and compassion (without overdoing it) into our psyche, we develop basic trust and enter into the world going where we are looking, feeling free to let our curiosity vs. our caution guide us.

When we go through life on a foundation of basic trust, having experienced and internalized what pediatrician and psychoanalyst D.W. Winnicottreferred to as “Good Enough Parenting,” (children don’t need perfectly attuned parents; to the contrary it is healthier for them to fill the gap created by the imperfections with self-determined growth and self-actualization), instead of vigilantly waiting for the second shoe to drop, we step into life with two feet ready to take it on.

Essentially, infants who grow into children and then teens and then young adults with a solid healthy core built upon basic trust are able to “take the hit(s)” from life with becoming destructive towards the world or themselves.

On the other hand, infants who grow into children and then teens and then young adults with a damaged core built upon basic mistrust are constantly worried that the next hit will be the one that destroys them forever.

As they grow, children with a damaged core develop cumulative vulnerability which increases as they become older, because each setback, upset and disappointment is just another trauma to be survived vs. be made stronger.

There is a point where damaged core children/teens/young adults find it increasingly difficult to focus and concentrate and perform, because the cumulative vulnerability crosses over into increasing fragility then panic, then terror as if the next setback, disappointment, upset, loss or failure will cause them to become brittle after which the next step is shattering, fragmenting and never coming back.

What is going on inside the brain and body through this is that cumulative vulnerability compounded by increasing fragility causes a massive outpouring of the stress related hormone, cortisol. When cortisol becomes too high it signals a part of our emotional brain called the amygdala to signal our blood flow to preferentially go from our prefrontal cortex into our survival fight or flight or freeze lower reptile brain. When that happens, we are unable to think or consider options or even listen to what we are being told. You get the idea if a doctor suddenly tells you that you have untreatable terminal cancer. When that happens, you can’t listen to a word he or she next tells you.

During the time our cumulative vulnerability is increasing we most often cope by fighting (getting angry, blaming and venting) or fleeing (literally running away somewhere or running into frenetic hyperactivity, excessive exercise, excessive dieting or eating, excessive video games, excessive shopping, excessive drugs, alcohol, extreme sports, etc.).

Over time, the fighting and flighting stop working and with that, we are unable to get away from the increasing vulnerability that is crossing over into fragility. At that point we begin to freeze. When that happens and without an externally directed behavior to stop the internal emotional tsunami that is brewing within, the fragility crosses over into brittleness, panic and the belief that we will shatter, fragment and never come back.

When this endpoint is reached and a person can no long “pair” with the reasons to live and feels that fragmentation is next, they enter into a state of terror from which there is no escape except to end their life.

That is when we become increasingly fixated on suicide as not just the only way to end the pain, but the only way to stop the brittle/panic/shatter/fragment/terror slippery slope.

BTW this is also the point at which veterans become suicidal and are looking into the barrel of a gun. It’s also the point where if they don’t want to die, but just want the pain to go away, they reach out and discover God, thinking or saying aloud and crying: “God, I don’t want to die, but I can’t take it anymore. PLEASE help me!”

Why do others who could and should not do anything?

Increasingly, because of the hyperkinetic and frenetic pace of our life, fewer infants, children and young adults are receiving patience, tenderness and almost never having someone join them in the dark night of their souls when they are most in despair and keep them company and pair with them.

Furthermore, a subconscious reason for caretakers to not step into the pain of deeply anxious, depressed and suicidal people is because it reactivates the unhealed wounds in the caregiver (who ironically were often drawn to their professions because of that wound) that they would rather run away with and not re-feel. You know the “there but for the Grace of God” thing.

One of the ways that caregivers and mental health workers deal with the deep pain of teens and young adults is therefore to throw well-intentioned, evidence-based treatments and solutions at it. Anything to keep their students and themselves from feeling the deep pain.

Years ago, one college student that I treated said, “When you have a chronic mental illness, you stop being a person. Instead you become a patient carved up into billable procedures that don’t talk to each other and each of which is delusional that you, the patient will turn the spackling into something that lasts. Welcome to my world.”

What to do?

Yes, a first step is to reduce all the external pressures that cannot be endured. And yes, it helps to create a more livable school/life/mind balance.

However, without also going into that core vulnerability built upon basic mistrust and fear, other measures are like putting lipstick on a pain.

As a medical doctor my view of deep psychic pain or what my late mentor and suicide prevention pioneer, Dr. Edwin Shneidman called “Psychache” is that underneath much of anxiety, panic, depression and suicide is a core abscess that needs to be drained. To do that it needs to be “felt” all the way through by the person feeling it. And to do that, caring family members and caring mental health workers need to find a way into the dark night of the soul of the person and keep them company there. That means not rushing in with yet another treatment that just puts more lipstick on a pain. It means helping them to “feel felt” so they will feel less along in hell and instead of pairing with death to take the pain away, pairing with loving, compassionate empathy. It also means staying with them as they make it back into the light the life.

After you go into that deep wound and keep such an anxious, depressed and suicidal person company using what I call “Interventional empathy,” you leave an “empathic drain” in (instead of rushing a treatment at them so you can check a box) and with time it will granulate (fill in organically from the inside-out) in with hope, pairing with you instead of death.

If you want to see how going to where someone is in their dark night of the soul can breathe life into them, I urge you to go and watch this video of Naomi Feil and Glady Wilson all the way to the end (you may have never seen it, but 1.3+ million other people have).

It’s astonishing. It’s what students who are heading down the path towards suicide need when they feel frozen and are slipping toward the abyss of that dark night of their soul. It’s what will cause them to pair with you and choose life over death.

I know you don’t have the time to do it. I know you have too much to do. I know you don’t want to stir up you own unhealed wounds.

The good news is that you may not have to be the one to do it, but make sure you find someone who can and will.

Calling Mary Poppins.Resources:

* Medium: How Des-pair Leads to Suicide

* Why People Kill Themselves: Death by Double Standard

* Why People Kill Themselves: Interventional Empathy for Suicide Hotlines — Seven Words

* Why People Kill Themselves — The “Save a Life” Conversation

* Why People Kill Themselves — Design Thinking Suicide Prevention

* About Teenage Violence: It’s the Rage — ebooklet

Dr. Mark Goulston is the best selling author of “Just Listen” Discover the Secret to Getting Through to Absolutely Anyone, co-creator and host of the upcoming documentary #StayAlive, and host of the “My Wakeup Call” podcast (and sadly, it was another tragic wakeup call that caused him to write this).

Now live on Youtube:

Dr. Goulston is the inventor of Surgical Empathy, a speaker, executive coach & the author of "Just Listen" which became the top book on listening in the world.

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