Review of "Suicidal Behavior in Children and Adolescents"
By Barry M. Wagner Yale University Press, 2009 Review by Rudy Oldeschulte on May 4th 2010
Our imagination is usually befuddled in our attempt to make sense of suicide -- to find the rationality or the reasoning. The act of suicide -- or its attempt -- perplexes us. The task of explaining suicide, either psychologically, philosophically, or sociologically, has been approached from the viewpoint of these different disciplines for centuries. Volumes of work have been published on suicide in an effort to shed some light on this long-standing practical problem -- to draw lines around the trajectory of its development in the young and to find means of prevention. Scholarly examinations, such as Kay Redfield Jamison's Night Falls Fast, provides us with an eloquent and rich account of the history and understanding of the despair and hopelessness felt by those that commit or attempt to commit suicide. Literature and film give us pause on the subject. A work by A. Alvarez (The Savage God) looked historically at writings about suicide -- in both literature and psychological studies, and noted that while there are innumerable writings on the subject, we still realize after reading these works, "that they are concerned with that shabby, confused, agonized crisis which is the common reality of suicide." More recently characterized in book and in film, Michael Cunningham drew our attention to the despair and the psychological strain leading to the contemplation of suicide in The Hours -- a rich literary depiction of Virginia Woolf's suicidal struggles and conflicts, with accompanying illustrative stories that portray the developmental and psychopathological trajectory of the events.
With so many perspectives and so many approaches in trying to understand and prevent suicide -- all of which grapple with the real life problem of suicide -- where does the clinician go? Barry Wagner's Suicidal Behavior in Children and Adolescents has given us the resource -- a plentiful and detailed look at the current state of professional understanding -- with a thorough and, though he humbly states otherwise, a comprehensive account of the enormous theoretical and clinical research to date. Wagner has done this in a qualified and masterful way, drawing together in one place an extraordinarily broad scope of research and clinical work, with attention to every possible avenue in comprehending suicide in young people. Every theoretical perspective -- developmental, family, cognitive, psychodynamic, biological, and psychosocial (as well as others, lest I miss one) -- is examined at length in his attempt to provide us with an integrative model. Wagner deals very effectively with the definitional problems, as well as the evolutionary quality of the diagnostic classification system -- a system that is far more useful in predicting, diagnosing, and ultimately benefiting prevention in young people. Wagner's inclusion of the facts, the factors, and the statistics is impressive, as he integrates these within a framework that aids our understanding of the myriad contributory factors in suicidal behavior. He gives us a fuller picture of the reality of the crises that suicidal youngsters struggle with in their mental lives. For example, and though only indicative of one of the factors involved in youth suicidal behavior, there is the "sense of fundamental disconnection from others," (Wagner). This sensibility is also characterized by other authors in their literary works or psychological treatises - be it Virginia Woolf, A. Alvarez, or Kay Redfield Jamison. However, in Wagner's Suicidal Behavior in Children and Adolescents, a sound and solid foundation for understanding the child or adolescent's attempt to escape the experiences that they encounter each day and find so disturbing -- and potentially dangerous -- is offered. This intolerable experience within the child's mental life may be described as E.M. Forster characterized being 'muddled:' that is, the individual's failure of connection and the 'tendency to live in fragments.' This 'muddled' experience may and often does reflect a movement toward a more substantial reaction to the crisis.
Our ability to respond to the practical nature of the problem and our need to understand all that we can of this "confused, agonized crisis" experienced by so many children, is well illustrated through Freud's letter to Einstein (1933) regarding our wish to prevent war. Freud commented: "The result, as you see, is not very fruitful when an unworldly theoretician is called in to advise on an urgent practical problem. It is a better plan to devote oneself in every particular case to meeting the danger with whatever means lie at hand." This attitude of practicality was further evident in Freud's comments in a letter to Rev. Oskar Pfister about a young patient in 1926. Freud wrote: "What weighs on me in his case is my belief that unless the outcome is very good it will be very bad indeed; what I mean is that he would commit suicide without any hesitation. I shall therefore do all in my power to avert that eventuality." (quoted in Litman, 1967)
The challenges and the complexity of understanding and responding in a practical, effective manner to suicidal behavior in our young people may seem overwhelming to clinicians, or to use Wagner's term, "daunting." However, Wagner has brought together for us a rich and thorough examination of what we need to know, and his work provides sensible suggestions for our main task -- that of what Freud was referring to in 1926 -- prevention.
Litman, R. (1967) Sigmund Freud on Suicide. In Shneidman, E.S. (Ed.) Essays in Self- Destruction. Science House, New York.