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One day in January 2002, the a mother attempts to hang herself in the bathroom, and sports marks on her neck; one of her sons helps to cut her down. That son, ten year old Kevin Vliet of Cleveland, was found dead in his bedroom, hanging from a bunk, within days.
The last person to see Kevin alive was his mother, whom he kissed and said, "I love you," before retiring to his bedroom and ultimately his demise. The cause of death was listed as suicide. The fact of his death was stunning - but the notion of his suicide was not. For this reason, Kevin's apparent suicide has exposed a neglected and high-risk subgroup of children and adolescents, with lessons that can help us save others.
Recent suicidology research includes attention to how suicides run in families. We know, for example, of the increased incidence of suicide in the offspring of suicide victims. Researchers have also demonstrated that suicide in biological offspring is six times higher than in adoptees of parents who commit suicide. Furthermore, as violent suicide has been associated with deficiencies in serotonin, research has also identified depressive disorders and subgroups of alcoholics who are serotonin deficient.
In the September issue Archives of General Psychiatry, Brent and colleagues from Pittsburgh and New York City released the findings of a study that compared families of mood disordered suicide attempters with non-attempters. Offspring of attempters had an increased risk of suicide attempts six times higher than non-attempters.
Is it only mood disorders, and a biological explanation? The fact that Kevin left this world, only days after he confronted the possibility that his mother was trying to, suggests otherwise.
How does a ten year-old process the prospect that the only person who loves him would rid herself of him forever? For a person especially buffeted by his mother's hostile boyfriend and an otherwise emotionally barren environment, it must be rather terrifying. Which makes one wonder, again, whether Mayra contemplated how destructive her suicidal gesture might be? And should anyone else?
In emergency rooms across America, mothers and fathers present to physicians, psychiatrists, counselors, nurses, social workers after having carried out a suicidal gesture. The pills that lead to the pumped stomach, the slitting of the wrists, the threat to jump, the noose around the neck, the hose on the exhaust, the range of scenarios that may or may not be associated with someone wanting to die are everyday occurrences.
Sometimes, they want to die. Sometimes they want attention. Parasuicides are known as non-fatal gestures that appear suicidal, but are carried out to satisfy another motive. Parasuicidal actions are found in 4 to 5 percent of the population of the United States. A professional can never can be completely sure without a careful assessment; how, therefore, does the ten year-old son assess his mother?
And how do we assess him? We don't, actually.
The children of suicide attempters, however, may be struggling with rage, fear of abandonment, and a host of enormous challenges. How do they handle this? Attention focuses on the parasuicidal parent, who happens to be in front of the interviewer and counselor. For the children of more histrionic persons who repeatedly find their way to emergency rooms after parasuicidal gestures, the experience of a parent's dance with death may repeat itself. Are there people we professionals should be protecting? Is that a duty?
At the very least, the growing research body and the Vliet case highlight the likely need to extend risk assessment beyond the emergency room. Parents who attempt to kill themselves manifest an act of exceptional neglect of their children. They certainly don't do it to enhance the welfare of their child. Perhaps this emotional cruelty and selfishness does not warrant the children being removed from the home; certainly the children benefit from stabilizing the relationship. In this age of outreach, however, shoring up support for the children and the uncertainty of their world may keep desperation from becoming unmanageable.
Structured protocols need to be developed to extend crisis intervention to the children of a parasuicidal household. Such outreach could well be coordinated through collaborations between emergency care and social services. In the meantime, greater efforts at the time of clinical intervention should focus the suicide attempter on a sense of responsibility for the fate and the emotional effects on their children.
It is only too selfishly convenient for the attempter to presume that because the attempt wasn't successful, the matter is finished and all is forgotten. A responsible and truly contrite person who learns from foolish choices at an impulsive and hopeless point in time will be able to rehabilitate him or herself, his or her child, and their relationship.
The Vliet case and thousands of parasuicidal stories that preceded it, show us that the parent immature enough to attempt suicide ignores its long-term impact on the child. Mental health and emergency workers should therefore lead in focusing on the problem of the forgotten child of the suicide attempter. Awareness and sensitivity will prompt some who are despairing to think twice, and seek help.
Is there a duty to protect the child facing abandonment? For all the psychiatric and suicide fallout, there should be. No child deserves anything less from a parent than the commitment to live.
- Welner, Michael; Have you checked the children?; Forensic Echo: Behavioral & Forensic Sciences in the Courts; January 2002; Vol. 6; Issue 1.
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