I’ve been working with non-suicidal self-injury, or NSSI, for about 14 years. Most of the people I help are cutters, burners, carvers, pickers, or other self-harmers who have no intent of actually killing themselves. Their interest in this admittedly dark behavior is far from a death wish—it is, in fact, the opposite. For most of them, it’s as simple as coping. The self-harm actually makes them feel better during times of great distress. For others, the scars left by various forms of self-injury are proud honor badges that memorialize a particular “war zone” that they were able to survive. And for a few, their bodies are the only place left to vent burning emotion that can no longer be suppressed inside of them.
But that’s not to say that self-injurers never feel “suicidal,” and I put that word in quotation marks for a reason. First, we have to discuss the term “suicidal.” For therapists, that term has a specific meaning with a specific clinical presentation and a specific historical pattern. We are trained to understand suicide from a particular lens, and that lens requires years of training and experience to master. It is such a technical term, in fact, that we have an obligation to distinguish between suicidal ideas, suicidal gestures, and even something called “parasuicide” (an act that may appear suicidal but is in fact a clever design aimed at accomplishing something else entirely).
The word “suicidal” doesn’t always mean the same thing to the layperson. And like many terms in the clinical psychology world, the word has fallen into the untrained, unexperienced, and under-developed hands of teenagers. (Thank you, Google.) For them, “suicidal” can cover a broad spectrum of emotional experiencing, including “sad,” “disappointed,” “frustrated,” “broken-hearted,” “humiliated,” and many other feeling states. What they have figured out (not because they are manipulative, but because they are just as intelligent and observant as we were when we were teens) is that the word “suicidal” gets a heck of a lot more attention and responsiveness than those other feeling words. What they haven’t figured out is that the word is losing its power as it becomes more and more uttered.
This creates all sorts of problems. First, and perhaps scariest, is that we all know what happened to the boy who cried wolf. The more teens say they’re feeling “suicidal” when they’re actually feeling socially isolated, or terribly embarrassed, the less the adult world can believe them. This leads to the second (also scary) problem: Teens are at the height of risk-taking behavior due to where they naturally are in their neurological development. (So were you.) If they want to “prove” how suicidal they are, they might dare to push the limit and take action on it. Worse, because the part of the brain responsible for maturity and long-term vision hasn’t fully developed, they might actually believe they are suicidal in the moment because their brains aren’t able to hold perspective yet.
The problems don’t stop there. Being “suicidal” holds social weight. Today’s teens are more likely to respond to each other’s emotional suffering than they are to other kinds of cues, so they tend to get trapped in a peer-validation cycle. One teen expresses that s/he is “suicidal,” and is rewarded with empathy and compassion. Another teen might want to relate by sharing her own story of suffering, or “suicidality,” and is rewarded with the same sympathy. And so on and so on.
And then there’s the alarming increase in teen suicide to consider. Parents, understandably, flock to the professionals as well as to the internet to ask how to tell if the “suicidal” feeling is real, how to respond to it either way, and whether a risk-taking teen with no intent to die could, in fact, accidentally kill himself.
I’m not sure my field is doing a very good job providing answers. I’m not sure I can do it very well myself. But I owe you my best effort, so today’s blog represents that:
- Mood fluctuation in adolescence is dramatic. Anticipate the rollercoaster. Sometimes a bad mood (a “suicidal” feeling) can be here one hour and gone the next. Don’t forget that teenage moods are governed almost entirely by social events. Look for context when your teen is very low. Has something happened in their social world? Wait an hour, a day, a week. Are they better?
- Teenagers do not want you to know that they are feeling better, because they harbor a very deep, very real fear that if they are better, you’ll forget about them. If you ask them directly how they feel, take their answer with a grain of salt. Trust your observations.
- Use your parent intuition and follow that with common sense. If you can’t tell whether your teen is suicidal or something else, become curious. Stop what you’re doing and ask some questions (not the how-are-you-feeling one because of #2 above). Ask about their friends, their grades, their teachers. Ask about college pressure. Ask about dating and break-ups. Share some of your own experiences. Say reassuring things without being condescending. Offer to find a therapist. Make their favorite dinner. Take them out to a movie or a sporting event.
- Follow through. If you do one or more of the things in #3, don’t let that be a solitary event. Do it again. Think of this as a time to channel your best cheerleader. Then do it again. Follow up on another day about what you learned. Keep saying reassuring things.
- We will never be able to answer the frightening question about whether teens could accidentally kill themselves because of the simple and sad fact that we can’t get answers from someone who has passed away. We hear about accidental overdoses all the time, but none of us can ever know for sure. Some suicidal acts (or parasuicidal acts) are certainly more dangerous than others, and yes, drug overdose happens way too easily. But cutting is different. It takes quite a lot of blood—half to two-thirds—to bleed out, and cutters usually don’t bleed very much. Furthermore, because they don’t have any intent to die, they usually call a parent or an ambulance if they worry they’re bleeding too much.
The line between suicidal and non-suicidal self-harm has become very blurry, and you’re not silly or stupid or naïve or overprotective to be worried about not discerning between the two. A lot of parents can’t. But you’re not alone on this one—don’t forget about therapists! When you really don’t know, and your intuition is failing you, call us. We’re trained for exactly this purpose. We’ll help you figure out what’s really going on.
– Angela Caldwell