A great deal of attention has been devoted recently in The Washington Post and elsewhere to suicides of young students on college campuses. Much of the analysis hits upon truly extraneous factors: One psychiatrist on ABC's "Nightline," for example, included the horrors of a potential nuclear holocaust as one of the causes for increased suicide rates. Sure, our students (as well as we older folks) are in despair over the potential end of the world. But when students kill themselves, we are witnessing something beyond pessimism and despair.
Why do college-age students kill themselves? After all, one hears retrospectively of a student's having had "so much to live for." In fact, despairing, suicidal students have often complained to me about the insensitivity of messages from loved ones who say, "You have so much to live for," and deny the validity of the student's pain and despair.
Although one cannot explain a complex human action like suicide in one broad stroke, the metaphor of the "forced march" may help to explain the phenomenon.
For any interminable forced march or forced labor, I would bet money on the survival of an older physically fit man over a younger equally fit man. The reasoning is simple: The older man has already endured many of life's struggles, and he can place this new struggle in better perspective. He can be more optimistic that this present painful struggle will eventually come to an end.
As modern neuroanatomists have shown, we never stop learning: New folds in the cerebral cortex develop with the resolution of each new crisis. Adolescents and young adults have not survived enough crises to attain those extra folds. They thus still tend to view the world in overgeneralized, all-or-nothing terms.
A crisis -- a breakup with a lover, bad grades, a rejection from graduate school -- feels as if it will have far-reaching, permanent consequences, with no end in sight except through death. Perhaps adding to the problem is what novelists like John Updike and Saul Bellow have referred to as our overly "sanitized" world: Illness and death have been exorcised from our lives -- only, too often, to intrude upon our lives in a way that is then overwhelming.
What other factors may be involved in the recent rises in college suicides? My analogy of life as a forced march may help to explain the impact of the increasing dissolution of nuclear families, not to mention extended families. When youngsters have had little access to one or both parents -- or no access to the true survivors, grandparents -- they then may have no one to turn to in the midst of a crisis. What is worse is the lack of a deeply instilled notion that they may be better off for having had this crisis and for making it through the crisis. Without an older adult around, kids can be enormously hard on themselves -- feeling that it is their own fault for not being able to handle a crisis. They feel humiliated at their failure, and they assume that this humiliation will last forever -- making suicide one of their only options.
What can be done then to decrease these suicide rates? In my experience, there is no use in demanding that extended families stay together or be more emotionally accessible to their children. Nor can we "unsanitize" the world by destroying medical advances and thus reintroducing more contact with illness and death at early stages of life.
My suggestions, instead, revolve around the therapy professionals. We get paid to be emotionally accessible, and, accordingly, the public should expect a great deal from us. Unfortunately, however, I would be a rich man if I got even $1 for each student who has come to me with complaints about prior therapy experiences. The complaints almost inevitably center on the therapist's failure to interact. (No mental health discipline is immune; psychiatrists, psychologists and social workers have been equally represented.)
Often the therapist has been unresponsive, failing to do much talking or any talking, in the patient's eyes. There may be plenty of rationalizations for this "blank-screen" approach by therapists, but, given the needs of students for an older adult who "bucks them up" in a crisis, these rationalizations do not wash. After such experiences, a student is frequently reluctant to seek out therapy during another crisis; and, too often, they have blamed themselves for the failure of the first therapy -- thus reinforcing a very negative view of themselves.
In addition, we need more books and movies like Judith Guest's "Ordinary People." Shortly after the appearance of the movie, students who had been depressed and suicidal for months flocked to our Mental Health Service -- anxiously awaiting their opportunity to meet a Judd Hirsch clone. How much better to consider talking with someone when in distress than to consider death as the only option.
We also need people who have experienced a successful psychotherapy to come forth and toot their horns. Too often, flushed with success, they have understandably put their former distress behind them -- unwilling to acknowledge to friends and colleagues what helped. We need, however, to break down the stigma of psychiatric treatment any way we can. Anything that helps to make psychotherapy a much more attractive option than death will certainly save many lives.