The Downward Spiral

Sep. 12, 1994

A psychiatrist tells families how to detect signs that a teenager may be at risk to commit suicide--and what to do about it

By Jill Smolowe

The problem is of frightening magnitude: 2,000 teenagers commit suicide each year, and for every suicide, there are up to 350 failed attempts. "In an age where the cult of youth is so valued, emulated and pursued," notes psychiatrist Andrew Slaby, "we have been unable to respond to our children and teens when they are in the greatest pain." Slaby's No One Saw My Pain: Why Teens Kill Themselves (Norton; 208 pages; $23), written with Lilli Frank Garfinkel, is a canny and compassionate attempt to make, and help others to make, such a response.

Using eight case studies, Slaby focuses on the severe depression that can trigger a teenager's suicide, especially its less obvious indicators. The deepening silence of the patient Slaby calls Chad, for example, or the perpetual weeping of Sarah; John's eerie paintings, or Bret's getting himself kicked off the hockey team. Often, Slaby writes, depression is exacerbated when a youth feels shame over a subject that is taboo within the family: homosexuality, an unwanted pregnancy, the family's unacknowledged history of mental illness.

The teenagers Slaby writes about share an inability to convey to others the depth and quality of their suffering. Their best efforts to describe what they are enduring may be found in journals or, most tragically, suicide notes. "I can't tolerate myself anymore," writes Sarah, once a vibrant college student. Writes David: "My mind is no longer my own, it seems."

Severe major depression, warns Slaby, "should be considered as life-threatening as any other terminal medical condition." He stresses that it is a treatable biological illness that requires medical attention. "Hospitalization of the acutely suicidal adolescent is not optional," he says. "It cannot be postponed until tomorrow." He urges parents to be alert to signs that their children are becoming seriously depressed--to trust their instincts and act when they sense that a youngster is spiraling downward.

In his practice and in his book, Slaby counsels families in which a teen suicide has occurred, although he makes no pretense that a family can ever put such an event behind it. "Truthfully, I don't believe that any family ever really heals completely after the death of a child," he writes. "Healing and coping--they're two different things entirely." He argues that the survivors should try not to feel guilty because they failed to prevent a suicide: "Some people kill themselves no matter what intervention takes place."

Slaby does have one culprit: guns. Fifty-five percent of the teenage boys who commit suicide do so with a firearm. Citing studies whose findings should be painfully obvious, Slaby concludes, "There is increasing evidence those who do not have access to a gun are not as likely to kill themselves."

Go Back to Shy David's Depression Page.