Q: A teen female patient of mine texted several of her friends disclosing that she felt suicidal. She did not disclose a plan, nor was there a suicide pact for her group of friends. Her stepmother found out about this text message several days later, and felt obligated to call the parents of all the friends who received the text message. The teenager was outraged, feeling increasingly isolated, as her stepmother's contact had caused those parents to revoke their own children’s social contact with her. My patient did not understand why her stepmother contacted her friends' parents, expressing that "it was none of her business." The stepmother felt morally obligated, and even expressed a potential legal obligation, to contact her stepdaughter's friends' parents directly. This proved a significant point of contention between these two individuals, who asked for my direct opinion regarding this scenario. How would you counsel this family?
~ Clinician in Portland, ME
A: Dear Clinician,
Suicide among youth is a serious issue—it is one of the top 3 causes of death in this age group. Depression is the most prevalent chronic disease and adolescents won’t fully develop their executive brain functions, including impulse control and future thinking, for another decade. This can be a dangerous and volatile mix with adolescents’ developmentally appropriate mood swings. No clinician, indeed no person, who learns of suicidal thoughts in a young person can afford to protect their privacy. As a pediatrician who discusses sex, drugs, and other risk behaviors with my adolescent patients, I observe confidentiality, with one exception: suicidal or homicidal thoughts. When a life is at stake, the child’s privacy cannot be observed.
Research shows that most suicides are preceded by the victim reaching out for help in various ways. Communications of any kind, including texts, social media, or conversation, need to be taken seriously by those who receive them, even if they are youth themselves. The first action to take is to ensure that this young woman gets the professional help she needs. The mistake the stepmother made was to try to “fix it” herself by reaching out to her daughter’s friends’ parents, rather than following the guidance of an experienced clinician.
Once your patient is connected with appropriate clinical care, her stepmother needs to reach out and repair their relationship. There is no more potent healer of emotional and relationship wounds than apology and forgiveness. The stepmother must apologize to her daughter, admitting that she was scared and did not know how to handle this situation. She must acknowledge that she made a mistake in communicating with her daughter’s friends’ parents and that she recognizes that this error in judgment resulted in her daughter being further isolated. The community as a whole would be helped by some focused education about the realities of teen suicide, particularly to discount the notion that suicidal thoughts are contagious and that, to protect one’s children, one must isolate them from friends who are struggling.
You can offer to “broker” the beginnings of this reconciliation by meeting with both stepmother and daughter. Your presence and moderation can help the apology and discussion stay on track.
- Help the daughter understand that her stepmother was scared, responding to her own emotions, and made a mistake.
- Help the stepmother understand that her daughter may not be able to hear what she has to say.
- Encourage them both to use “I” rather than “you” statements – “I did this and felt that way” rather than “You did this to me.”
- Encourage them both to listen, letting each other finish their thoughts rather than interrupting.
- Help them each to be direct, rather than hedging, both about how they feel and about explicit apologies. The stepmother should acknowledge and respect her daughter’s feelings of betrayal.
- Encourage explanation, not excuses. The stepmother can explain that her choices were wrong, but she was scared.
- Discuss what each wish they had done instead. Acknowledge that with 20/20 hindsight, the stepmother should have connected her daughter to a doctor or professional counselor in a respectful and confidential way to help her work through her struggle and come up with coping strategies.
- Acknowledge the courage it took for the daughter to reach out to friends and thank her for sharing her suffering so that those who love her could help her find ways to cope.
- Offer to speak with the daughter’s friends, to remind them how important they are to the daughter, demonstrated by the fact that she trusted them with her cry for help, and her friends’ parents, to reassure them that communication of powerful feelings among friends is normal and beneficial, suicidality is not contagious, and that relationships among their children are healthy, even when one of them is struggling.
Cries for help by adolescents in crisis are not new, the digital environment in which these cries occurred is. Unfortunately, many parents feel incompetent in and often, like this stepmother, afraid of the digital domain – and they have defaulted it to their children. As a result, kids (and many parents) have come to believe that the digital domain is their private space, impenetrable by parents. But since youth spend so much of their time online, parents need to parent them there, too. They need to be present for their children when they are in distress, but also when they are bullying, sexting, or neglecting more important activities online. Whether by “friending” their children on social media or having access to their accounts, parents can parent their children in the digital domain, guiding, teaching, and intervening on problematic situations just as they do IRL (in real life).Enjoy your media and use them wisely,