It’s Ok To Say Suicide, A Conversation with Dr. Laurie Freeman and Dr. Laura Erickson-Schroth and John MacPhee from the JED Foundation
By Himani Dixit, MD
On October 27, 2022, NYC-Parents in Action’s Parent Lifelines: Online Seminar Series presented an insightful conversation between Dr. Laura Erickson-Schroth and John MacPhee, both from the JED Foundation, a non-profit that protects emotional health and prevents suicide for our nation’s teens and young adults. The seminar was moderated by Dr. Laurie Freeman, a psychologist in private practice, NYC-PIA Facilitation Chair, and former NYC- PIA Board member.
Dr. Freeman introduced the speakers and noted that this topic has struck a note with many in our community who have questions and are interested in what our speakers have to say. After the speakers introduced themselves and their backgrounds, Dr. Freeman started the discussion by saying that “raising kids now in the independent school community in New York City is difficult due to the amount of stress and pressure” put on kids from a young age.
What follows is an abbreviated transcript of the seminar, highlighting the main points and advice that was discussed.
Dr. Freeman: Parents are wanting to know how to have conversations with their adolescent kids to understand “how their kid is really doing.”
I think the most important thing is building that foundation from an early age to set the groundwork early. Empasize that this is a family where we can talk about difficult things. -Dr. Erickson-Schroth
Dr. Erickson-Schroth: I think the most important thing is building that foundation from an early age to set the groundwork early on. Emphasize that this is a family where we can talk about difficult things. Also, modeling the behavior that as a parent you have coping skills to deal with difficult issues, and having conversations about mental health and how emotions affect us is crucial.
Mr. MacPhee: I would add that young people are putting a tremendous amount of pressure on themselves. It’s important for us to not add more pressure. Adolescents today have more of a sense that their future is binary – either they succeed or fail, so it’s important to emphasize that there are multiple pathways to success. Data shows that concerns about their future is one of the biggest stressors. It’s important for us to “bring the temperature down a little and be a sounding board.”
Dr. Freeman: How do you have the conversation where you are really “getting to the heart of the matter?” Like if the child is saying everything is fine, how do you dig deeper? A lot of people are asking what do we look for to make sure our kid is safe or whether they are really serious when they say something like, “I don’t want to live anymore?”
Dr. Erickson-Schroth: Things to look out for are 1) is there a period when what they are going through is really affecting how they behave – do they seem to be off or doing things differently? Look at things like sleep, appetite, weight up or down, loss of interest in things they used to enjoy, whether they are connecting to their friends, substance use, etc. Also more serious things to look for are feelings of hopelessness or statements like “I don’t want to be here anymore.”
It’s important to trust your intuition and instinct and now [should this be “not” instead of “now?”] overthink it. Have the conversation and lean into that gut feeling you have and ask “Is everything ok? Something seems off with you.” Address it, don’t avoid it. – Mr. MacPhee
Mr. MacPhee: Sometimes it’s hard to tease out what is typical teen behavior versus when something is really wrong. It’s important to trust your intuition and instinct and now [should this be “not” instead of “now?”] overthink it. Have the conversation and lean into that gut feeling you have and ask “Is everything ok? Something seems off with you.” Address it, don’t avoid it.
Dr. Erickson-Schroth: A lot of people are afraid that talking about suicide will cause a child to act on it or give them the idea, but actually the research shows the opposite, that a conversation provides relief and encourages seeking help.
Dr. Freeman: What might a parent actually say to start the conversation?
Dr. Erickson-Schroth: You want to establish a good setting. Everyone has set aside their phones, and you make it clear that it’s a safe place and that you are really listening to them. I wouldn’t go straight to asking about suicide, but you might start the conversation by saying, “I’m worried about you and I wonder what’s going on. And then fill in specifics, like I noticed you’re missing lacrosse practice, or I notice that you’re not talking to your friend.” What you think might be going on might not be what’s actually going on. In terms of bringing up suicide itself, don’t be afraid to say, “You know sometimes people have thoughts about not being around, or thinking it might be better if they weren’t here.” It’s good to start off soft, and you can have those conversations in stages.
Mr. MacPhee: Even if the teen is not ready to talk at that time, you have shown them you are a safe harbor, they may come back to you. Even if the teen doesn’t open up, the conversation could still be a success to create a foundation of an open dialogue. There are data that show that non-parent caring adults are very important in the lives of young people. So think about the village of other adults you can activate around your child. Grandparents, aunts and uncles can check on your child. The benefits of those relationships also go in both directions.
Dr. Erickson-Schroth: It can be hard to feel like you are losing that control that you want to be the one your child talks to, but often parents are the last person a child wants to talk to. The more you can do to encourage other adults to be involved in your child’s life, the better.
It can be hard to feel like you are losing that control that you want to be the one your child talks to, but often parents are the last person a child wants to talk to. The more you can do to encourage other adults to be involved in your child’s life, the better.-Dr. Erickson-Schroth
Mr. MacPhee: We like to say that we want as many potential doors as possible. We talk about a “no wrong door” approach.
Dr. Freeman: In a way, the child might be protecting the parent from how bad they’re feeling, so if they have another outlet, that might be very beneficial.
Mr. MacPhee: And it’s more than just an outlet, because we know that talking to an adult is protective. It’s giving them a broader sense of community and family that’s protective.
Dr. Freeman: One conversation can plant a seed for future conversations
Dr. Freeman: What is the difference between a kid that is harming themselves like with cutting versus someone who wants to end their life? How do parents differentiate between those and what are the signs?
Dr. Erickson-Schroth: I would separate very much self-harm from suicidal thoughts, they are really two different things, even though they may seem like they are on a continuum. Self-harm is more of a coping mechanism, and it provides some sort of distress. That feeling of physical pain helps them get through difficult situations.
It is true however that sometimes people will make suicidal statements even when they are not really thinking about suicide as a coping mechanism.
These coping mechanisms are mal-adaptive. Either way, something is wrong and they are really struggling underneath. Even though the two are separate, there is a 50 to 100 times greater chance for a suicide attempt for a teen that is self-harming. We need to help young people to build coping skills.
Dr. Freeman: What are your thoughts about what parents can do to deal with the pain themselves if they see their child cutting, and then, how do parents effectively address it with their child?
Dr. Erickson-Schroth: It is really a difficult situation to see that your child that you’ve raised is harming themselves. You don’t have to solve every problem – turn to outside support to get help for yourself and your child. DBT (dialectical behavior therapy) is one of the mainstays – it involves mindfulness, distress tolerance, and emotion regulation among other things. It can involve the whole family.
Dr. Freeman: Before getting to the point of therapy, how does the parent respond to their child where the child is coping in these mal-adaptive ways?
Dr. Erickson-Schroth: Recognizing and saying to the teen, “I can see you’re really hurting and that you wouldn’t be doing this to yourself if you weren’t hurting. Let’s figure this out together and find a way to help you.” A lot of times teens feel like they are not being seen, or nobody knows how hard it is for them.
Mr. MacPhee: A lot of times we see that a friend actually tells their own parent that their friend is cutting. What do you recommend, Dr. Erickson- Schroth, in these situations?
Dr. Erickson-Schroth: Basically, your child is holding some sort of secret about their friend. Make sure that your child knows that they did the right thing by coming to you, and that this is going to help their friend. A lot of young people are worried that their friend will get in trouble or they will lose the friend if they “tell on them.” But ultimately, even though the friend might be mad at them now, they will usually be grateful in the future. We are the adults, and we have the responsibility to reach out and make sure the other parent knows what’s going on.
If you know your child’s friend really well, you may want to be the person to have that conversation with the child. It really depends on how well you know the child and the connection.
Dr. Freeman: What suggestions or thoughts do you have when a suicide has happened in your child’s community? There might be secrecy or shame around it – how to best handle this scenario?
Mr. MacPhee: It is so distressing and unsettling. A sense of stability, solidity, and predictability are so important, as are trying to maintain a sense of normalcy but also being available to talk to them so they know they can come to you. We call this period post-vention. It’s a tricky period because we want to make sure that we don’t glamorize suicide or the person who has died in a way that might motivate a vulnerable student to take their own life, but we also want to honor the person who has died.
Sometimes, the school is muted in their response, but it is often for a purpose. Suicide is the second leading cause of death of young people but it is still a rare event, so we want to make sure we are not over-communicating that it’s happening more than it actually happens because we don’t want to normalize it.
Dr. Erickson-Schroth: Sometimes young people blame themselves for a friend who commits suicide, and say things to themselves like, “I can’t believe I didn’t realize Joe was struggling…” You want to emphasize that prevention is helpful and does work, there’s nothing they could have done on a personal level and this was not their responsibility. Talk to them when they are ready to talk about it, but don’t try to push when they are shut down.
Dr. Freeman: What are your thoughts about books or TV shows that have suicide in the mix? Does suicide get glamorized in our culture?
Mr. MacPhee: The media can be very important in the way they portray suicide and mental health. We do a lot of work advising media companies on how to handle the subject. We are encouraged by today’s content creators on the whole, they seem much more interested in getting the portrayals right. Examples of talking openly, seeking help, having successful conversations with older adults, etc are all important in how mental health is portrayed. “13 Reasons Why,” was an example of it not being portrayed well, mainly because the adults in the movie were incapable, and gave the idea that going to an adult wouldn’t be helpful.
We are encouraged by today’s content creators on the whole, they seem much more interested in getting the portrayals right. Examples of talking openly, seeking help, having successful conversations with older adults, etc are all important in how mental health is portrayed. “13 Reasons Why,” was an example of it not being portrayed well, mainly because the adults in the movie were incapable, and gave the idea that going to an adult wouldn’t be helpful. -Mr. MacPhee
Dr. Erickson-Schroth: “Heartstopper” is a great portrayal of two gay boys in the UK who meet in high school and fall in love. What’s great about it is how the boys talk about their emotions to each other and their parents, so there is little miscommunication. A great example of how a show can be interesting but still positive and accurate in how a healthy relationship should function.
Dr. Freeman: Do you think that there’s something going on between social media and culture that increases kids’ sense of despair or distress?
Mr. MacPhee: Rates of suicide and the trajectory really started to change in 2010-11 when the internet met the phone. There’s not clear data that social media is not bad in terms of outcomes, but it really depends on how it is being consumed. There is an opportunity cost however – time spent on social media takes time away from family meals, face to face time with friends, time outside, and sleep, for examples. How do you restore balance with real life?
Community connectedness is so important to mental health. There are positives to social media though – there are young people who would have no connection otherwise. -Dr. Erickson-Schroth
Dr. Erickson-Schroth: Community connectedness is so important to mental health. There are positives to social media though – there are young people who would have no connection otherwise. For example, a young gay person in Alabama may have no one nearby to talk to, but now can attend a zoom meeting in NYC to a support group. Lots of young people are meeting first on social media, and then meeting in real life and having a real life friendship.
You can have young people do an inventory of social media for kids that are struggling on how to use it. Have them list what platforms they use, how much time they spent on each, and how it makes them feel. They have a sense that you are working with them. Then, from there, they can delete certain apps or notifications, unfollow, or use other techniques that will modulate usage.
Mr. MacPhee: We also have to take a look at how we model social media usage with our kids. That could be contributing to the problem.
Dr. Freeman: You’re both really saying that one factor is how much time are we spending on social media that is taking away from real life interaction, and the other is what are you looking at online that is making you feel bad about yourself. Do you have a sense of what these teens are looking at that is making them feel bad?
Dr. Erickson-Schroth: One is comparisons, especially girls and young women. Information overload is another big one. Studies show that we are taking in as much information in one day that our ancestors were taking in their whole lives. It also hijacks our reward systems. Watching out for the number of likes or comments you get – this does not help people to build distress tolerance or to be ok with being bored, etc.
Mr. MacPhee: The average teenage before COVID spent one hour or less outside – that is less than an incarcerated person.
Dr. Freeman: What is the impact of all the issues of the pandemic on mental health, self-harm, and suicide?
Dr. Erickson-Schroth: It’s had a huge impact. It took young people at a crucial moment in their lives when they are looking to build relationships, friendships, and social connection. Some teens were stuck in homes that weren’t very supportive or did not have many resources. Prevented sports and exercise – which has been shown to improve mood and decrease depression. It also increased social anxiety, panic attacks, and agoraphobia. It’s hard to go back after two years, especially for young people who don’t have the years of experience going in and out of social situations. I’ve seen young people who can’t leave their houses. It’s been a very difficult time for young people.
Mr. MacPhee: Creating an independent identity from your parents is crucial at this age. So young people are delayed in their social emotional development but also in creating those independent living skills. Young people are very concerned about social justice and political issues – so young people are also feeling the stress of all that, especially with the information overload. So it may be helpful to turn some of that off (like turning off the news) to make the environment a little bit calmer.
Dr. Freeman: What signs do we look for in terms of kids that are taking medications that may cause scary side effects like suicidal ideation?
Dr. Erickson-Schroth: There are two types of medications. There are the type of medications that young people may take to help with depression or anxiety, and then there may be meds that are non-psychiatric that may have side effects related to mood or suicidality. For antidepressants like SSRIs there was a black box warning put out in 2004 because there was a small but statistically significant difference in suicide attempt rates. I think that had a negative effect because prescriptions dropped after that, and people were not being treated the way they needed to be. It’s important to have those early conversations with your child and their doctor, and pay attention to anything that may come up and look out for. We don’t want to discourage people from using these medications if they may be helpful. Most young people that take these medications do not have these side effects, but it’s important to know that it may be a possibility.
Mr. MacPhee: Ideally you have a physician or a child / adolescent psychologist who is helping manage the process. But also, it’s important to not stop any of these meds abruptly.
Dr. Freeman: It looks like we’ve had a full hour, and I so appreciate what you’ve both brought to our community. It looks like the main points are keeping an open channel of communication with our children, to emphasize that they know they are being seen and heard, that we are approaching them when they want to be approached, and we’re not afraid to ask hard questions.
I really appreciate you emphasizing the difference between suicidal thoughts and using suicidal language or self-harm as a coping mechanism. A lot of things you said are very encouraging and positive like trying to build community, having other adults in their lives, and having positive real life experiences.
Thank you so much – I think we’re going to end here.