Youth and Consequences

Adolescent mental health in the new millenium.

Searching for solutions in the wake of suicide

Is preventing suicide the same as promoting life?

Last week a student from my home University, Cornell, took their own life. This marked the second time in less than a month that a student jumped from one of the many bridges spanning the beautiful, if at times lethal, gorges in Ithaca, New York. The day after, while en route to my office, I was delayed near a bridge that pretty much only ever saw delays for one reason: an accident on or near the bridge. Less than five minutes later my fears were confirmed, in the wake of our already overwheling losses was yet another. In just under one month 3 students had jumped off Ithaca's bridges and died.

A sobering mist has since settled over the campus.The security guards assigned to walk and watch the bridges since the last student jumped provide an odd sort of comfort but ultimately raise more questions than answers. How could so many bright young minds opt to end their lives? What could we, should we be doing to keep Ithaca's beautiful gorges from becoming unwitting graves?

Unfortunately, to these questions we have only partially satisfying answers. Suicide and suicide clusters are far more common than tolerable and effective interventions far more sparse than we would like. Suicide is the third leading cause of death among those 15-24 and suicide clusters, such as that just experienced at Cornell, may be increasing in prevalence. The tight link between mental illness and suicide renders adolescents and young adults vulnerable since onset of mental illness is most common in these developmental periods. Even more sobering is the fact that in many cases, the act comes as a total surprise - at least until the psychological autopsy is through and loved ones, friends, and acquaintances begin to piece together the puzzle.

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That said, it is also important to note that overall suicide rates in the US have not increased appreciably in the last quarter decade and Cornell's suicide rate is no higher than rates on other college campuses - they are simply much more dramatic and thus publicized. Indeed, it has been several years since Cornell has had a single suicide. Cornell is also highly proactive and very dedicated to creating a caring and supportive college environment. But even these efforts fall short and find no remedy in the literature about how to prevent suicide before the idea of it lodges in the mind of someone likely to nurture it to its obvious end.

Ultimately, the truth is that we are not good at knowing who is going to die by suicide. Despite a strong research base in warning signs and risk factors, our real life capacity to proactively identify individuals likely to commit suicide is profoundly poor; we are much better at seeing the patterns emerge in retrospect. And, while these psychological postmortems lead to important and interesting insights, they are often of little help in preventing loss of life.

The security guards pacing Cornell bridges are now regular fixtures as I walk to work and are likely to be there for some while. In addition to their more instrumental roles as surveillance officers, they are a palpable reminder of what we wished we could have done differently. The real problem is that we don't know what we should have done differently. Despite decades of suicide prevention research and practice, there exist no highly effective strategies for preventing suicide in all or even most cases - especially once someone is resolved or has reached the edge of the bridge.

So what do we do?

Suicides are profoundly tragic and jarring, but they also open windows of opportunity for reflection and innovation. The clear persistence of suicide throughout history suggests that it is a part of the human experience. Until we live in a radically different time and consciousness, one where people are never driven by internal or external demons to look for a way out of intractable suffering, we are not likely to be effective at eliminating suicide altogether. However, because the act so powerfully prompts those of us left behind to reflect on the sacredness of life and the role we individually and collectively play in easing the suffering that results in suicide, it leaves in its wake a deep inspiration to act; to care; to create webs of support that might catch those among us whose suffering becomes intolerable. In this way, acts of suicide invigorate and inspire innovation and remind us all of what really matters in life. And, it is out of this heart-centered and reflective place that we need to draw inspiration for making change.

From this deeply humane place comes insight into what we could do differently. Widespread initiatives aimed at helping all of us, not just clinicians, recognize signs of psychological distress now proliferate. These are joined by increasingly innovative early screening programs, such as those offered by the American Foundation for Suicide Prevention (http://www.afsp.org/) and that under development by dedicated intervention developers such as Cheryl King and colleagues at the University of Michigan. Ready access to a plethora of resources, such as the suicide hotline (1-800-273-8255) and numerous on-line websites dedicated to providing support, information, and interactive tools are also helpful and increasingly easy to access. Peer-based programs such as the Sources of Strength initiative that equips adolescents to identify, respond to, and alter norms around help-seeking reach deeper into the social ecology of youth.

This evolution - away from seeing therapists and other clinical providers and the "stoppers" of suicide, is important and has opened the door to new ways of thinking about our collective responsibility and capacity. Indeed, in recognition of the need to move upstream in the suicide prevention chain, a recent Centers for Disease Control funding announcement is devoted to exploring the relationship between suicide and the murky but powerfully resonant notion of "connectedness." This expansion is critical because it acknowledges that those individuals and institutions to which each of us is connected are the places where both our suffering and our healing happen. It acknowledges that suicide is as much a cultural disease as it is a biologically-based mental disorder and that effective solutions need to begin long before the idea gains traction in a vulnerable life and mind. In other words, preventing suicide starts at home, in schools, and in communities - not when someone's suffering becomes intractable or enters a therapist's office.

Moreover, in the wake of repeated suicide and suicide prevention efforts we have learned another valuable lesson: we should not be preventing suicide. Instead, we should be promoting life. Research shows unequivocally that when we increase a sense of connectedness, belonging, meaning, and mattering, we decrease mental illness, including suicide. This is more than a linguistic caveat, it is brings with it an entirely different orientation than frameworks intended to prevent bad events.


Our schools and colleges are critical settings for development - only some of which is academic. Of equal importance is emotional, social, and spiritual development. How do we create campuses and communities that enhance development? How do we help our youth and students ready themselves for a real life - one that includes not just work and productivity, but a healthy inner relationship with oneself and others? How do we create health promoting communities, cultures of connectedness, and authentic resilience?

It is my hope that in the aftermath of tragedy will come a deepened commitment to answering these questions. While we clearly need effective strategies for dealing with crisis - both the before and after - our real work starts long before this point and demands a collective dedication to promoting reasons to live and assistance in thriving.


If you suspect that someone you know is at risk for suicide, please visit the following websites: the American Foundation for Suicide Prevention (http://www.afsp.org), the JED Foundation (http://www.jedfoundation.org/), and/or the Suicide Prevention Resource Center (http://www.sprc.org/).

 

Janis Whitlock studies, writes, and teaches about adolescent mental, social, and emotional health and development at Cornell University.

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