Page - 251 - in Psychoanalytic Perspectives on Puberty and Adolescence - The Inner Worlds of Teenagers and their Parents

Lost by the wayside – overstepping limits 251 Only in the session with his therapist does David realize that he was risking his life; it is as if he had split off his capacity for taking care of himself. The therapist is meant to take care of him and assume the fear for his survival. Although these covert suicidal attempts were not consciously planned by David, the risk of their succeeding was no less substantial. Death from “accidents”, particularly automobile accidents, is the most common cause of death for adolescents. In the USA, 45% of adolescents who die between ages 15 and 24 do so from accidents, 16% from acts of violence and 12% through suicide (Balk 2014, 64). How many of these accidents were actually covert sui- cides cannot be determined. The particular susceptibility adolescents have for suicidal thoughts and suicide attempts has come to be considered a serious problem by pedagogues and parents in the last 20 years. It is now common knowledge how important it is to take adolescents’ remarks concerning death seriously. Anderson cites a series of risk factors that point to the planning of a suicide. The following is a list of risk factors which can be borne in mind: 1 Preoccupation with themes of death expressed in talking or writing 2 Expressing suicidal thoughts or threats 3 Actual suicidal threats or gestures, even in the distant past 4 Prolonged periods of depression, such as change in sleeping patterns, too much or too little sleep or sudden extreme changes in weight or eating 5 Withdrawal and isolation from family and friends 6 A history of prolonged family conflicts and instability 7 Deteriorating academic performance reflected in lower grades, dropping lec- tures and tutorials, and dropping out of school or college activities 8 Pending disciplinary issues in school or college 9 A history of severe or prolonged bullying 10 A history of family suicides 11 Persistent abuse of drugs or alcohol 12 Major personality and behavioral changes indicated by excessive anxiety, or nervousness, angry outbursts, apathy, or lack of interest in personal appear- ance or the opposite sex 13 Recent loss of close relationship through death or suicide, or a suicide within school or college 14 Making final arrangements, leaving a ‘goodbye’ note, drawing up a will, or giving away prized possessions 15 Telling someone of their state and intentions (Anderson 2009, 232ff ) Close observation of the adolescent’s behavior by family members and friends can help assess – or reduce – the risk of suicide. The mere fact that close friends and family members are paying attention can send a signal to the suicidal adoles- cent that it matters whether or not she lives.