Understanding Suicidal Feelings in Children and Adolescents

Blog written by Emily Strainchamps, LICSW – September 2021

Franciscan Children’s Behavioral Health Services

As a clinical social worker, I’ve sat with many adolescents and children struggling with feelings of suicide.  These are four questions that I consider when thinking about suicide risk in these age groups:

• Are they dealing with layers of emotional pain and stress?
• Do they believe that their situation can be changed?
• What is their capacity for verbalizing complicated feelings?
• Do they actually want to die, or do they want to escape?

I believe that for most people, it is not the intensity of an emotion, but the experience of having multiple painful emotions, that is overwhelming.  One specific feeling that I always look for is shame.  Shame is a particularly powerful, all-encompassing emotion, especially for children and teenagers.  In his book Shame: The Power of Caring, Gershen Kaufman describes shame as the feeling that “one has simply failed as a human being.”

Years ago, I worked with a 16-year-old girl* who tried to kill herself after she was told that she couldn’t finish out the cheerleading season.   She had gotten her second concussion in a year and both her parents and doctor deemed it too risky for her to continue cheering.  During our work together, I discovered that she missed being with her friends on the cheer squad, as well as the popularity that typically comes with being a cheerleader.  Most importantly, she believed that she had cost her team their long-coveted championship: “I couldn’t look any of them in the face, ever again. I had let them all down.”

Another factor contributing to suicidality in kids and teens is their belief that the pain they’re experiencing will never end.  Often, youth don’t have the ability to envision the possibility for different outcomes.  This is partly because their pre-frontal cortex is still undeveloped.  It’s also because they haven’t had the life experience of knowing, as adults do, that “time heals all.”  This factor is often seen in kids and teens who are being cyberbullied.  Certainly, not all kids who are cyberbullied will become suicidal, but for some youth, seeing cruel messages show up every time they look at their phone can feel like an unending torment.  They may feel trapped, not knowing how to make the comments stop.

When helping patients I also think about whether that child or teen has any limitation in their ability to describe their internal process.  If you think about youth that don’t have the words to describe the complexity of their emotions, then you can imagine that they would have difficulty verbalizing their experiences in a way that adequately conveys the intensity of the pain they’re feeling to the adults around them.

For example, I once worked with a 12-year-old boy* who was starting to be aware of his same-sex attraction. The boy came from a family that spoke English as a second language and disapproved of homosexuality due to cultural beliefs.   He didn’t feel that he could confide in anyone around him.  Instead of naming his fears, he began drawing figures of males with frightening, distorted faces and bodies. A teacher at his school noticed this compulsive habit and approached his parents about his drawings.   His parents brought him to therapy and discovered that he was struggling with depression and having thoughts of suicide.

Finally, I find that it is important to understand that sometimes suicidality is a “wish to escape an experience” rather than to actually die.  When I talk with youth who report feeling suicidal, one of the questions I always ask is, “If you could make this situation stop, or if you could go live somewhere else, would you still want to die?”  Often kids will say no, that they just don’t know how else to escape from a painful situation.  That opens up a whole new conversation and allows us to talk about other kinds of solutions.

Ultimately, I’ve found that suicidal feelings usually come from the conviction that there is no way to change a deeply painful, untenable situation. As parents, teachers, and therapists who interact with children and adolescents, it is important to realize that our ability to ask questions and check-in with our kids is a powerful means of challenging the notion that the only way to escape is by harming themselves. We don’t need to solve their problems or necessarily take away all of their painful feelings; we can start by helping them to understand there are other solutions that they have not yet discovered.  To quote the poet Emily Dickinson, “we can help them to ’dwell in possibility’.”

*Note: all identifying information has been changed.