Some of the underlying causes of youth suicide and self-harm
Much work has been done to try to clarify the reasons why young people kill themselves. We know that young people who are depressed are more likely to go on to complete suicide, but it is important to state that it is still only a relatively small percentage. It is also the case that drug and alcohol misuse is certainly more common in those who die by suicide.
Drugs and alcohol tend to have a two-fold effect. The first is that they, in time, act as a depressant, making low mood more likely. The second is that they tend to decrease inhibitions, and therefore remove the internal controls whereby one prevents oneself from engaging in self-harm or suicide. It is also important to be aware that drug and alcohol misuse can be a marker, in any young person, for increasing levels of unhappiness or distress. It is not unusual for those who are unhappy to turn to drugs or alcohol to give themselves a lift, but, as has been mentioned, the effect is short lived and is replaced by a further deterioration in mood. When young people self-harm, they give a variety of reasons, but certain themes quickly emerge. The most common of these is the break-up of a relationship, or other peer difficulties.
Another common situation is difficulties at home within the family, and such difficulties can either be of longstanding duration or acute. Less frequently young people describe a build-up of pressure, either academic or otherwise, which generally leads to mounting levels of tension and stress and a feeling that a young person cannot cope. If this happens in the context of a personality which is somewhat perfectionistic and rigid in nature, where a young person does not allow themselves the option of “failure”, the result can be catastrophic because a young person’s problem-solving competence in such situations becomes significantly impaired, as does their list of possible remedies.
This issue of problem-solving difficulties is a recurrent one in young people because in many cases of self-harm a young person’s ability to generate an alternative solution is defective. This happens for a variety of reasons.
The first of these is that, for many young people, their ability to put words to their feelings is at a relatively undeveloped stage. Even though we live in an age where psychological terminology is far more part of the common usage than it was in the past, there is still often a gap between a young person’s awareness of the meaning of a term and their ability to apply it to their own situation. Young people discover, as this ability improves, that they can develop some sense of control by being able to articulate their own internal world, and their developing capacity for abstract thought allows them to discuss these topics in a different way. It is also important to remember that our brains work in a way that makes it more difficult for us to think creatively and flexibly about a difficult situation if we are emotionally aroused. Our ability to generate solutions, to estimate risk, to predict the responses of others, and to manage ourselves through such difficult situations is never as good when we are agitated or distressed as when we are calm. We tend to “catastrophise” whereby we imagine the worst possible outcome and therefore react, which can involve self-harm. Self-harm also develops as part of an on-going pattern. While it may start in a situation where people feel acutely distressed, it often becomes a means of regulating one’s levels of discomfort. Hard though it is to believe, young people who cut themselves while highly distressed describe, not a sense of pain, but a sense of relief. There are many theories as to why this may happen, but fundamental to understanding this dynamic is to realise that, for a young person, cutting themselves may not always be a painful or a distressing act.
Essentially, young people harm themselves (either by cutting or by overdosing, or by drug or alcohol misuse) to get rid of unpleasant feelings. It can create a cycle whereby they believe that the only way to get rid of such feelings is to carry out that specific act, and a pattern ensues. That is the reason why many people who harm themselves on one occasion go on to repeat such an act. It is by no means always a suicidal gesture, and while a very unhelpful way of coping, must be seen in context. In this regard, cutting is the most common method of self-harm which becomes repetitive.
Overdoses tend to be more serious, and are far more likely to have lethal intent. Hanging and choking are almost always lethal with respect to intent and must be taken very seriously. The one exception to this is that many young children, either in their early teens or perhaps younger, can engage in either breath-holding or asphyxiation games in order to induce an altered state of consciousness. While this does not, generally, have lethal intent, it is quite likely that, in situations where people carry this out alone (by using a ligature) they may be unable to release the ligature in time, and this has led to loss of consciousness, and even death.