The definition of suicide contains two components – that the individual brought about his or her own death, and that he/she did so knowingly. Attempted suicide or suicide is usually carried out at the height of an interpersonal crisis. Suicides can be grouped in to two broad categories. The first group includes those deaths comes as a surprise to his/her acquaintances.Often these are individuals who have led stable lives but whose stability has been precariously dependent on one other individual.
The other sub group is chronically maladjusted individuals. They have a long history of personal difficulties, conflicts with the law, work instability and sometimes interpersonal violence.
Teenagers who attempt suicide have similar difficulties to their adult counterparts, but in many cases they also face problems in their relationships with their parents. Although psychological and psychiatric issues are found in most individuals who attempt suicide, only a third are found to have definite psychological disorder. In many cases this is transient, being largely secondary to social difficulties. About 5-8% of individuals suffer from serious psychological illnesses, which require treatment in a hospital. The most common disorder is depression, with anxiety and schizophrenia (a serious psychiatric condition) occurring in few cases.
morePersonality disorders ( Anti - Social Personality Disorder and Borderline Personality Disorder being the major ones) and issues related to drugs(legal/illegal) are also common, especially among young males.
Attempted suicide is primarily a behaviour of the young adult, and is particularly common in under 35-year olds, but seldom occurs under 12 years of age. Throughout adolescence, the incidence increases markedly among girls, reaching peak in the 13-24 year age group.
The incidence is highest among individuals of lower socioeconomic status, and in people in urban areas characterised by social deprivation and over crowding. Many individuals who attempt or in complete suicide have a background of disrupted family relationships, often because of early parental death, separation or marital issues. Approximately 65-75% individuals who make attempts are facing problems in their relationships with their partners. A major relationship issue or separation is the most common event preceding the act.
When asked "why did you do it?" many will reply "I just don't know". Some may answer "I just want to be out of this crisis". Most of these teenagers do not realise the cardinal issue of suicide that it is the end of everything for ever. ' They just want, not be in the difficult situation temporarily.
A minority of individuals will declare that they were attempting to terminate their life. More commonly there is considerable doubt in the individual's mind as to whether this was so, and they professes having felt indifferent as to whether they survived or succumbed.
Counsellors should be aware that the teenagers feelings at the time of the act may be very different from those at the time of the interview, that the acute crisis may be over and the subsequent events may have intervened clouding both recollection and interpretation.
Primary prevention of attempted suicide appears to be difficult. Some individuals who are in a state of extreme crisis may benefit from a brief period in hospital. About 30-40% of individuals appear to be suitable for brief problem - solving counselling sessions on an out-patient basis. Counselling should be directed towards the individual and her/his family members. Cognitive behavioural therapy techniques may be helpful. Occasionally medications (anti depressive/anxiolitics or sedatives) may be required for a brief period and should be supervised by a family member. Repetition could be reduced by social and life style changes.
In a crisis situation at a school (eg. violations of rules) a student should be sent to the school counsellor to ascertain the issues regarding the incident and to decide the best way to deal with the issue (especially the home environment). In a serious issue involving a student, the student should be informed that the school has to inform the parents for her own welfare, but should be assessed the home surroundings before informing them. The child should have a trusted safe person (In Sri Lanka it is generally an aunt, or a friend) where the school authorities could discuss this issue with the child, especially if the parents can not handle the situation with out harming the child physically or mentally This becomes easier if the school counsellors has information by interviewing the child.
When a child commits suicide in the school premises, the "blame game" begins and the parents blame the school authorities and the teachers who are involved in the "incident" has to "take" the blame. Teachers and school prefects who are directly involved with the issue suffer intolerably by blaming themselves for the child’s suicide. Most of the times times the parents are blamed and they suffer untold grief due to loss of their loved ones.
The media and the education authorities have a major role to play in this sought of unfortunate situations and should try to diffuse the crisis to prevent these teen tragedies happening again. The teens should be educated to cope their crisis in a safe way to prevent "copy cat" suicides.
Courtesy - The Island By Dr. R. A. R. Perera
