Shame: The Underestimated Driver of Suicide

“I had actually lied to my closest people. More and more I realized that the moment would come where my construct of lies would become shaky. And I started to think that putting an end to my life would be easier than unwrapping everything and telling people that I had lied to them.”

This is what a young man who had survived a serious suicide attempt told me in the follow-up therapy.

A study on 13 boys

In 2013, Annelie Törnblom and colleagues from the Karolinska Institute in Stockholm, Sweden published an amazing but rarely cited qualitative study on in-depth interviews with parents of 13 boys who had died by suicide [1]. Parents often blamed themselves for actions either taken or overlooked. On the other hand, parents typically described that their boy concealed problems and hid behind a mask.

For example, he could mislead professionals, saying that he would never consider suicide, or take a morally wise position with friends: ‘‘I’d never do that to anybody.’’ He could play the clown, would not reveal any problems, pretended to be happy, lied, manipulated and hoodwinked others. When the parents tried to confront him, he fooled them by flatly denying any problems. “I’m just going out for a while, and we can talk when I get back.” He never came home again. In trying to understand the suicide of their sons, the core issue that came out from these interviews was shame: “Shame for what the boys had done. Shame for what happened to them. Shame of physical appearance. Shame for who they were.”

A case vignette

The parents of Oliver (18) came to see me after the suicide of their son. Oliver was in his second year of an apprenticeship in a travel agency. The parents noticed that he looked somewhat preoccupied. When asked, he denied any problems (“No, why do you ask? Nothing’s wrong with me, everything’s in control, school and everything”). The deadline for the submission of his final diploma thesis approaches. Mother offered to see the draft—maybe she could make some useful comments. The deadline was Monday. On Saturday afternoon Oliver said he went to the travel office to print the manuscript. An hour later, he came back to fetch paper for the printer—which mother found rather odd, considering that he was working in an office where you would expect plenty of paper supply. Oliver did not come home. Two days later he was found dead in the forest.

The parents were devastated, helpless, trying to understand. They talked to Oliver’s friends and teachers. Oliver had not attended classes for weeks, although he left home and came back every day as usual. When the parents searched his laptop, they found that he had not even started to write his thesis. Oliver’s parents had not noticed any changes in their son that, even in retrospect, could have been signs of depression. Mother said that she had told their children that it was important to talk openly about any problems, that they could tell her everything, and that lying was not the way to deal with problems — a parental attitude probably most of us would endorse.

Obviously, Oliver had tried to keep up the image of a “normal boy” vis-à-vis his family. Yet, he had developed a construct of lies, which, the longer it lasted, the more difficult it became to overcome and tell the parents the truth. The outward identity he tried to keep up did not match his inner life. I am sure that his parents wouldn’t have made a scene had he managed to tell them the truth. For instance, he could have said “I need to tell you something. I have a problem.” It would have been as easy as that. We think.

In adolescence, the sense of one's own identity is a fragile seedling

To develop a sense of identity is an enormous task. Most of us have had periods where we felt that something was not right with us, that we were not like others, where we blamed or even hated ourselves. Maybe you remember how you tried to conceal your deficits and your shame. Men, but young men in particular, are extremely skilled in hiding problems that occupy their minds, in order to avoid cracks in their self-image. They may feel inadequate when comparing themselves with their parents or with cool peers. Weakness is something to be ashamed of. They develop a rather convincing identity toward the outside, the peers, the parents. They keep failure and weakness to themselves. But what they try to appear to the outside is not congruent with what they feel inside. This, however, may become life-threatening when the “no-problem” mask leads to a dead end from which it is difficult to back out.

I have seen caring and engaged parents who lost a child by suicide. Most of them had not noticed anything special in their child or, upon asking, their son or daughter denied any problems. I asked young patients I saw after a suicide attempt what occupied their minds when they harmed themselves. What I often heard was “being wrong,” not fitting in with peers or siblings, and not being acknowledged as the person they are by their families. As a father who lost his son by suicide, I know how difficult it is to bridge the generational gap between a parents’ sense of identity and that of their children. It is not surprising that, generally, adolescents would rather talk to peers about their problems than to their parents.

Shame as a driver for suicide is not only a problem of young people

The parents of a 48-year-old man, married with two children, who had ended his life by suicide, came to see me. They described their son as a successful lawyer in a government position and dedicated father. The parents also mentioned that his father had an extremely high sense of responsibility and reliability—which at the age of 58 had led him into an existential crisis where he made a serious suicide attempt. The son, like his father, was reliable, responsible, and highly respected as a lawyer, which got him into a top position. When his boss, who had personally supported him in his career, retired, the work situation changed. The new head of the department took his work ethic for granted and burdened him with more and more tasks. He was unable to tell his new boss that he was unable to cope with the workload. He developed extreme insomnia, problems with concentration, came home late from work, lost energy, and withdrew from his family. His wife and his parents worried about him, yet he insisted that everything was OK. One morning, instead of going to work, he went to the railway track and ended his life.

Shame Essential Reads

Shame, Stigma, and the GLP-1 Treatment Journey

Stepping Beyond the Darkness of Shame

How can we teach people to accept shame as a normal human condition?

As something that isn’t worth hiding and endlessly ruminating about? That we can accept shame as a normal emotional reaction everybody knows. That we need to put the thoughts, which threaten our self-esteem and our sense of identity into words we can write down or talk about. Yes, it may be particularly difficult to confide in our loved ones. Turning to health professionals may be easier, but it means overcoming a barrier. A study which explored young people’s experiences in primary care settings found that adolescents were very sensitive about the clinician’s approach [2]. “Being a good listener is one of the vital things. The way they sit or look at you, their gesture is very important. You don’t want to be ignored at that moment when you’re telling your story. When they’re typing, you kind of feel like, “What are they typing? Now I feel like maybe I shouldn’t say that. What if they type it into the system? Things like that”.

Self-guided digital mental health interventions have increasingly gained attention as novel and cost-effective alternatives to traditional mental health projects. Self-guided digital interventions help to maintain autonomy, allow contact any time, with anonymous access, avoiding barriers related to the fear of stigma, shame, and prejudice against negative experiences with healthcare providers [3].

ChatGPT offers a low-threshold therapeutic relationship (although it can also cause harm in some cases (see my earlier post). I tried to put myself into Oliver’s shoes. I told ChatGPT that I should deliver my thesis for my diploma on Monday, and that I had not managed to start with it but had told my parents that it is done. ChatGPT answered: “Regarding your parents, it's understandable that you're afraid. People often lie when they're overwhelmed because admitting they're struggling feels even scarier in the moment. But if Monday arrives without the thesis, the lie is very likely to come out anyway. Telling them yourself—before they find out from events—gives you some control over the conversation. You could say something as simple as: "I need to tell you something difficult. I told you my thesis was finished, but it isn't. I got overwhelmed and kept putting it off, and then I was too ashamed to admit it. I know I broke your trust, and I'm sorry. I'm trying to figure out what I can do now, and I wanted to tell you myself instead of letting you find out another way."

Would this have kept Oliver alive? We don’t know.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.