Adolescent Suicidality: Grieving for Childhood

It is not uncommon to hear our adolescent patients refer to themselves as ‘losers’, sometimes even emphasising this by holding a thumb and index finger perpendicularly to each other to signify this self-designation with an insistent, symbolic ‘L’.

They often articulate this (and we often hear it) as a reference to their somehow ‘losing in the game of life’, feeling defeated by their inadequacies or insufficiencies, unable to triumph in the developmental provinces that are most meaningful to them – achieving a rich social life, or academic excellence, or artistic virtuosity, or athletic dominance, or romantic attachment.

But it might be more accurate, and more clinically valuable, to understand the ‘loss’ that is being referred to not simply as a ‘failing to win’ but as the loss of childhood. Because completing the work of adolescence means saying goodbye to childhood, mourning for the past in preparation for creating a future.

What makes the grieving process so complicated for teens is that they typically do not understand that they are grieving, nor do they have more than a dim, fleeting awareness of what they might be grieving for – at least not right away. The ‘no longer’ of childhood and the ‘yet to be’ of adulthood both appear as vague and dreamlike, and they remain hopelessly amphibious, torn between who they once were and who they are about to become.

Navigating through adolescence essentially means stumbling across the uneven topography of grieving but without any guiding cartography for grief, desperately trying to find a resting place for that which must be left behind. 

With this in mind, when I listen to my teen patients express suicidal thoughts or display suicidal actions, I am not listening for what is wrong with them, but for what they are trying to say. And what they are often trying to say is not that they want to end their lives, but that they want some help coming to terms with the part of their life that they intuitively sense must come to an end.

Taking a systemic perspective

The treatment of adolescent suicidality is of course complicated even further by the fact that teens are not the only mourners. Adolescence happens to adolescents, but also to their entire family. So while they are struggling to say farewell to their childhoods, their parents are struggling to say farewell to raising a child, and we are never more necessary and more relevant than when we are rearing our young – that is what evolution has designed us to do.

But when teens begin the process of separation and individuation, they industriously and inescapably nudge their caregivers into the twilight of insignificance, and propel them a little bit closer to mortality. This can create such psychological discomfort that parents may disown their unutterable feelings of grief and out-source it to their children, who (often subconsciously) upload it for their parents, carrying a double-load of grief when one is usually sufficient to weigh them down.

In my clinical work, I have found that enlarging the conceptual framework when treating adolescent suicidality is invariably a source of considerable revelation, relief and resolution for teens as well as their families. Because, particularly when it comes to adolescents, the suicidal urge can often best be understood not as a desire to terminate one’s life, but as a desire to mitigate the pain of one’s life.

So when we help both teens and their parents to understand the source of their pain – the unavoidable developmental losses that accompany human growth – we can join with them to help them to grieve and to heal, to honorably pay their respects to the past so that both generations can contemplate and pursue a healthy and meaningful future.