"Behind every teen suicide attempt lies a story of pain and alienation. Understanding this is key to prevention."

"I'd like to know what these thousand people were doing the day before, before they were able to call this resource. What were they doing the day before, with that need to share their suffering with someone? In that sense, we should see it as something hopeful because someone was there to answer those calls. There were already helplines operating that receive calls continuously, like the one in Barcelona (900 925 555) , but it's positive to add a new number that is also easy to remember."

"The book is about life, like everything else really; we know very little about death. With the title, I wanted to reflect a feeling that people who have attempted suicide often convey to me: that feeling of 'dying' before making a decision like suicide. It focuses on the process of suicidal behavior, which isn't something that arises suddenly, but rather a whole path that develops slowly, starting in the intimacy of one's thoughts. One of the things we professionals try to understand is how a 15-year-old decides that this is the solution; we want to understand how they got there. After seeing hundreds of boys and girls who have gone through this, we see that there's always a story, a whole process that's important to understand because the only way to prevent suicidal behavior is to get ahead of it , that is, to intervene when this process is already underway. And that's the process the book focuses on, that preceding path."

"As a clinical psychologist, I already had extensive experience treating young adults with pathologies considered complex, such as borderline personality disorder. When I was offered the opportunity to implement the program addressing suicidal behavior in minors..."

At Sant Joan de Déu Hospital in Barcelona, in 2013, I felt I had the appropriate training and preparation, but I had to undergo a complete personal and professional transformation to confront the reality I faced every day. Knowing the theory alone was no longer enough; I had to start from scratch, to "strip away" everything I knew, because I saw it wasn't helpful. We have to understand that most studies on suicide have been conducted on adults. In the case of adolescents, who account for 2% of total suicide deaths, attempts were made to adapt that knowledge, but many things didn't fit.

Trapped in a "brave new world"

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Monograph

It's a path where I stripped myself of everything I had to face this battle and understand the reality of adolescent suicidal behavior. My initial approach was scientific, through a research project aimed at answering questions such as the typology of at-risk adolescents or quantifying the types of processes they exhibit (mostly long-term difficulties with adjustment, family, school, etc.). At that time, there were few published articles on the subject; we were at the very beginning.

Writing this book stems from my commitment, especially to the families. When we see these young people, we find them already at the stage where they've made an attempt, at the end of the process, and that's very hard to accept. It seemed unfair to me that this painful experience should remain confined to the consultation room and not be shared, that we couldn't turn it into something useful for society .

"Suicidal behavior is multicausal and yet it isn't. Ultimately, it boils down to pain, hopelessness, and the capacity for suicide. In other words, the pain and hopelessness stem from any factor that generates significant distress and exceeds that person's capacity to cope."

The important thing in this process is to create elements of connection with life because that connection is incompatible with wanting to die . Human beings are like that; our ties to life are what prevent us from abandoning it. And it's not about suppressing pain either, because the painful or difficult situations we experience throughout life help validate us, strengthen us as people. What worries me is that we're giving young people everything ready-made, delaying their entry into the job market. We parents try to make sure they lack nothing, but with this approach, they don't have the space or time to demonstrate their worth. They don't have the reasons or opportunities to earn things for themselves. I think one of the reflections we must make is what kind of world we are building for them. And it's not easy; we're a bit lost ourselves too. We have to find moments for them to break down doors, and for that to happen, there have to be doors. If we aren't able to let them forge this personal path, that's when confusion and a feeling of emptiness arise.

“We are deaf to this reality, and I would go even further, we silence it. If a young person expresses these thoughts, they often receive responses like, ‘Don’t talk nonsense.’ And when a suicide attempt occurs at home, we cover it up because we think the way to protect the teenager is to keep others from knowing they attempted suicide, so they aren’t stigmatized. And it’s the same in the educational environment. We have a serious problem when adults decide that the best thing for the child is not to tell their tutor, for example. If the teacher doesn’t know that the child is going through a difficult time, it will be hard for them to help when the child returns to school. If the teacher has the information, they can be more attentive, talk to the other teachers so they can be more patient, so they can adapt to the situation. When we don’t tell anyone and the child returns to school, the teachers don’t change the dynamics; they apply the same pressure that may have led the child to the suicide attempt… but, of course, without knowing it.” And the problem isn't with the parents, but with society because they know that this issue still carries a lot of stigma, and until we break that stigma, we won't move forward.

Guidelines for parents and friends facing the risk of suicide in adolescents and young people

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It's funny because before writing the book, I thought the solution, at least professionally, also involved sharing all this knowledge so that professionals and other groups involved in education or leisure could become more engaged, better understand the phenomenon, and see what they can do from their own perspective. But, of course, you only achieve that when you finish the book, and now I realize that the difficult part is overcoming the first barrier, which is preventing people from taking a step backward just by looking at the cover. Yes, it's a tough, uncomfortable topic, but a necessary one.

"The answer is simple. A person who thinks it's better to die than to keep living is someone who is going through a difficult time for various reasons and is experiencing significant psychological suffering. They feel they can't escape this pain and that they won't be able to overcome it. They feel completely disconnected from life because they don't like themselves, they think they're worthless, and that they haven't been able to prove their worth anywhere. And, furthermore, they believe they are a problem, a burden to their loved ones. These are people no one turns to for comfort, and they have no one to turn to for comfort or with whom to share this situation. This is what happens to the teenager, and that's why, in the end, they end up thinking it would be better to end it all."

It's crucial to take seriously any sign a teenager might be sending about suicidal thoughts. A suicide attempt, however minor it may seem, tells us that the young person is already caught in that process and we must intervene. If we wait, they will eventually become more capable of doing what they want to do until they succeed. The ultimate goal is to get to the root of the problem, and it's important for these young people to know that their parents' love is unconditional, that they won't be better off without them—quite the opposite, in fact.

"The World Health Organization has always reported a ratio of 20 suicide attempts for every completed suicide in the adult population. This ratio increases with age; in older adults, we're talking about 3 suicide attempts for every completed suicide. This is because the capacity for suicide increases with age. In adolescence, we have more opportunities to intervene because adolescents reveal their intentions earlier. It is with these adolescents that we must work to prevent them from committing suicide in adulthood."

We don't yet have data on the impact of the pandemic, but, in general, we know that mental health-related issues have increased, and we fear this will ultimately translate into more deaths. During the two months of lockdown in 2020, there was a decrease in suicide attempts, followed by a spike at the end of the year. I thought this would balance out the data, but no, there were record numbers. This leads us to believe that the 2021 data will not be any better.

"Attention-seeking is an idea associated with a child's tantrum, a way of getting what they want through emotional blackmail. We all know that we shouldn't pay attention to this behavior, and that's when the tantrum intensifies because the child sees that attention has been withdrawn. When they realize that doesn't work, they try another behavioral approach that may be more effective. Suicidal behavior has nothing to do with what we understand as attention-seeking."

When a child tells you they want to commit suicide, it's very hard; it's very difficult to accept that idea. That's why the initial reaction is to think they're trying to get attention. But, of course, what are they supposed to do? Not tell you? A young person who threatens suicide or attempts it doesn't improve their social relationships, doesn't make more friends, doesn't prevent their boyfriend or girlfriend from leaving them, doesn't improve the relationship with their parents—they don't achieve anything; everything gets complicated. When this behavior first occurs, friends show concern or interest, but if they continue, eventually people distance themselves from them, and that ends up being another factor adding to the problems they already have. It ends up confirming that feeling of loneliness, of being worthless, of only being a burden to others.

To think that this behavior is for attention seems cruel to me. Popular wisdom has invented reasons or explanations for things we struggle to understand; this is also how myths related to suicide are maintained. But these explanations comfort most people, not the person suffering. To combat these myths, we need to understand and know how to act.

Myths and False Beliefs about Suicide

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“When I began to confront this reality, I did so very ‘naked.’ In that sense, I was clear that I wanted to explain what I would have liked to know before facing this reality. I'm confirming, based on what other professionals tell me, that it truly fulfills this function, and that always has an impact. I've always been certain that it should be a useful tool. As for the content, as an example, I also address the myths we've had in the professional field. Concepts that we've been taught as professionals and that, later, in daily clinical practice, you realize don't fit, such as lethality, rescueability, etc. They give professionals a false sense of security, but they don't work, at least not in the age group I work with, which is children under 18. I think professionals can't afford to be without this knowledge, which is now available to everyone with the book, including families, educators, and other interested individuals.”