STI: Young and troubled

April 2, 2009

Doc talk

Young and troubled

By Dr Brian Yeo 

 

My heart sank when I received a letter from the police. It was a request for a medical report for a patient who had committed suicide.

 

To me, the taking of one's life seems to be a rejection of all the help and concern of everyone who cares.

 

I have always taught in our medical school that the highest risk of suicide occurs in the elderly who are isolated, medically ill and depressed.

 

Usually, their final act is well-planned, with wills written and notes left for loved ones about where their money and other assets are and what had to be done about their remains.

 

Many give heartfelt advice and thanks to their loved ones.

 

While we invariably regret this final act, at the back of our minds, we may have understood why they took their lives although we would never have agreed with that decision.

 

However, it is heartbreaking to see teens and young adults, who, still in the prime of their lives, cut short their lives.

 

The recent articles about the spate of young people taking their lives engenders fears that others may copy their actions as they feel that suicide has somehow become more common or acceptable.

 

For the young, suicide is an impulsive act and the chosen method over the years, from local data, has been a dangerous and irreversible one - jumping from a height.

 

Before the suicide, there might have been precipitating events like being scolded, failing to meet academic grades or being rejected by the person that they love. The final notes left behind, if any, contain the person's anger and frustration.

 

Many of his friends and relatives will have expressed shock over such an act.

 

They will report that the individual had not expressed his wish to end his life. These friends and family members may, on reflection, report that the individual had become more withdrawn.

 

Looking deeper into these cases, I believe that many individuals who contemplated self-harm had a perceived sense of isolation, although surrounded by peers and family.

 

What had happened was that they found themselves unable to communicate one-to-one their deeper feelings to others, even to people close to them.

 

Yet in today's digital age, many do write their darker thoughts in their blogs and online diaries.

 

While many teens who write and share their angst online will not commit suicide, one of the few ways one can spot some of these vulnerable young individuals is from their postings on the Internet.

 

The spontaneity and immediacy of the Net make it easier for these individuals to share the very feelings that they convey to friends and family in day-to-day interactions.

 

Concerned friends can thus quickly pick up these changes and respond to these postings, opening up the channels of communication.

 

Parents will probably find that being more computer-savvy is useful in this day and age.

 

If, for instance, their channel of communication with the child is not deep or open, they might want to look at his blogs. These blogs are usually not restricted and may have been posted to elicit a response from their viewers. Many friends do respond and some have conveyed their concerns to other friends, their teachers or to school counsellors.

 

Many teens have been brought to see me by worried parents who had seen their troubled entries in blog postings. Some had been alerted by their children's teachers and friends who had been aware of these postings.

 

While there is usually the inevitable initial resentment, these teens usually come around and understand their parents' concerns.

 

I can vouch for the many who turn out well. Psychiatric consultation can help open up communication between a teen and his family, which builds up mutual trust again.

 

The vulnerable teen must always feel that there is a way out with trusted people whom he can turn to - instead of just ending his life.

 

Caregivers need to build and strengthen that safety net, liaising with the relevant school and religious body, besides providing useful helpline telephone numbers.

 

There are moments when we need a 'get-out-of-jail card", to enable us to confidently step out of a perceived impassable morass with trusted and non-judgmental support, and to embark on a new cycle in our lives.

 

Dr Brian Yeo is a consultant psychiatrist in private practice and adjunct associate professor at the department of psychological medicine at the Yong Loo Lin School of Medicine, National University of Singapore. He is also a certified master substance abuse counsellor and is currently the Singapore Medical Association representative to the Board of Management, Singapore Anti-Narcotics Association.