by Steven Gledhill for FREEdom from MEdom Project
People in the world are broken. The world is broken, as evidenced by most everything in the news these days. At home and in our neighborhoods, communities, and even in the church community, people are broken, and so many feel that it is hopeless beyond repair since they feel helpless to do anything about it.
Men and women, and boys and girls, turn to alcohol and drugs and other destructive devices, to remedy their pain. People cause harm to themselves and one another. Many end up in and out of prison, and back in again. Many others cause enough harm to themselves that it costs them everything, including their very lives. Teenagers battle pressures and pain so intense that they self-harm (self-injure) and battle overwhelming thoughts and feelings of making it go away through the act of suicide.
(Note: Images below are taken from Google Images and are not actual patients.)
“Everyone is not okay as they wander through life, and when we know people intimately we will find that much has been stolen from them, that many hearts have dried up and died, and that they cannot find a way out of those prisons by their own power.” —Francis Leeman
When a person self-injures by using a sharp object (i.e., a knife, box-cutter, razor blade) against their skin, is it suicidal behavior? Maybe it is, or maybe it isn’t at all. Is there a difference between someone who is in distress and someone who is in despair? Is there much difference, if any, between someone who feels helpless and someone feeling hopeless? This chapter tackles the challenge of trying to understand all that. It is not a formulaic, easy-fix dilemma to sort through and requires some real conversation; a discussion which might draw some conclusions while generating some more questions to debate along the way.
While there is so much war across the globe today, there is another war on the home front. It is the battle in the minds of young people waging emotional and spiritual warfare against their innocence, using hopelessness as a weapon to literally drain the life from their souls. The enemy uses deception to lie to our kids, persuading them to believe that they are failures that will never live up to anyone’s expectations; especially their own. This adversary takes advantage of flawed brain chemistry to seduce people, especially teenagers and young adults, into a realm of despair that advances thoughts and feelings of self-harm, escalating the urge to terminate life.
In the image of Humpty Dumpty up their on the wall, it appears that he has taken a few too many falls in his life but somehow found ways to get back up and find his place again in the world. But since we have read the rhyme, we know how it turns out for Humpty Dumpty. At some point he has fallen and and broken so bad that he is beyond repair; a hopeless, helpless failure.
It’s something pretty tragic for a nursery rhyme to tell children, although there may be a lesson in it for kids that typically take uninformed risks. Parents warn their children of harm every day: “Don’t touch the hot stove!” “Don’t run into the street!”
Unfortunately and far too often, children ignore the repeated warnings and impulsively do the thing that warrants attention in the moment, placing their hand on the stove and getting burned; running into harm’s way and getting hit. Children tend to learn the hard way that they are not invincible. Some, however, over the course of their lives, seem to never learn. Why is that?
Some children have experiences quite different as they grow up and are victims of neglect and abuse. For so many, their experience is perpetual trauma. It’s as if they never stood a chance. They may develop symptoms of severe anxiety and stress, depression, and often are symptomatic of behavioral and mental health disorders. They can be abusive to others as well as themselves. Their issues may involve alcohol and drug abuse, severely dysfunctional relationships, and social problems in their communities that may include anti-social behavior that may involve criminal activity.
Abused and neglected children left alone without sufficient love and support growing up (although fed plenty of shame) end up feeling betrayed, rejected, and abandoned. If they have not experienced what it is and means to be loved, how would they know what love is? How do the unloved comprehend love?
They typically understand what shame is and what it feels like. Once one has experienced pain, it is associated with any number of emotional sensations and experiences. Injury is real and hurts. Without adequate help and support, neglected and abused children can struggle to articulate in their own minds what has happened to them.
Their wounds run deep and are left open and exposed. Each time there is harmful friction against exposed wounds the pain intensifies, becoming intolerable. What these young minds too often conclude is that they are indeed worthless, feeling hopeless, and helpless to change their condition and course in life. What a typical day looks like is more of the same; as if it matters. The damage done is palpable, felt through physiological symptoms and problems fostering adverse biosocial and psychosocial experiences.
The emotional properties of these young people can be impaired to the point that they shut down in an attempt to not feel anything. They have become experts in repressing pain and discomfort. For awhile not feeling hurts less than feeling. They may turn to alcohol and drugs to disable the pain. They might choose other methods like cutting themselves or perhaps starving themselves as a distraction from what hurts the most. Young teenagers might engage in sexual behavior with those who will prey on their vulnerability. It all comes as a shock to their oblivious parents and loved ones when it all comes to light.
I once worked with a young lady who for four years had been drinking until she passed out; all by the time she was eighteen years old. She’d been sent home her freshman year from the university she attended when I treated her alcohol dependence. She would make progress, then lapse back into her addictive habits, then get clean “for a minute”, then lapse… you get the idea. She had experienced tremendous pain in her young life; feeling like she never measured up.
What can be a vicious cycle is when, after numbing pain by any means necessary, these wounded warriors might one day come to recognize the condition of being so cognitively dissociated that they feel indifferent in much of their real-life experience. (A ten year-old boy once told me, “My happiness doesn’t matter.” Did I say that he’s ten? … 10! I also know of a ten year-old boy who recently hung himself to death; was rescued, revived, and today suffers from severe spinal cord injury and brain damage because of it.) Dissociation in this context suggests that when it comes to life circumstances and relationships, including harmful past relationships, there is a disconnect to the point of not feeling much of anything.
Indifference in actuality is a powerful emotion that expends energy. It is unacceptable and also requires a remedy.
I recall a number of years back ministering to an adolescent boy, twelve or thirteen years old at a youth retreat. He shared his story of emotional abuse and neglect against him by his parents, and other forms of physical abuse in the home. This kid was eye-witness and recipient to the culture of abuse in what is supposed to be a safe place. It was so prevalent to his reality that he was one of those kids that shut down emotionally until he didn’t feel anything anymore. He was bullied at school, and yet didn’t mind being the bully. Getting hit he felt something. He also cut himself to feel what he referred as relief from the (emotional) pain he suffered in his home. Cutters that self-injurer prefer to feel the pain of cutting over feeling nothing. (Studies indicate evidence that self-injury, such as cutting, whether or not it is of primer for suicide, is a mechanism for producing endorphins—a kind of pain reliever; an alternative instead of suicide.) This boy liked to fight. He was the last kid anyone wanted to fight since he said it felt good to him to get hit, and it felt just as good to dish out a beating.
The best part of that retreat was getting to pray with this boy, then hearing his testimony of deliverance. God is so good that way. Jesus, his Savior, showed mercy and favor on this kid and it changed his life. His whole countenance seemed to change from that day forward. It is an awesome thing to see when God’s transformative power is at work and his healing work is evident in the lives of His kids.
Working at an Illinois correctional facility, one of my clients was an early twenty-something African-American man who had three children from a couple of young women. Like many of the men in prison, he never knew his father and his mother was an addict prostituting herself for drugs and unable to care for her children. My client and his older sister were in the foster care system. These siblings were very close and only had each other as family. So when they were assigned to foster parents they were a package deal. So when a single foster mother sought out my client’s sister to be a sister to her daughter, the judge ordered that she had to take my client as well. He was eight years old and his sister a couple of years older.
My client’s foster mom adored my client’s sister. She treated his sister as if she was her own daughter. My client’s sister grew to be quite close to her foster sister and began to alienate herself more and more from her brother (my client). It was a process of abandonment and she likely was too young and immature to recognize what it was that was happening to him. In any case it was the reality for my client; something apparently encouraged, if not insisted, by the foster mom.
My client reported that he does not recall being physically abused or molested as a boy. What he did experience was extreme neglect and emotional torture. At mealtime, the foster mom, the foster sister, and my client’s sister sat around the table and enjoyed well-prepared meals together. My client was positioned to sit in a corner of the kitchen, away from the “family” table. He was given what was leftover to eat, right out of the cans the prepared food came from. What he ate was usually ill-prepared. He ate from cans and boxes of packaged foods for the next few years until he ran away from home and was raised by “custodial guardians” of the streets of Chicago. By then he was old enough to run for them, look out for law enforcement, and things like that. He lived in drug houses and what were essentially brothels for addicted men and women, boys and girls, to get high.
One thing my client did mention was that on his birthday, his foster mother did bake him a cake and throw birthday parties every year. I asked him if his foster mom allowed him to invite his friends over to the house. He told me that the other kids at the party were his sisters’ friends. (His sister and foster-sister shared many of the same friends.) They all sat around the table, while this young boy was isolated away from the table. At least, he had cake. My client looked down at the floor. He looked back up and away, avoiding eye contact with me. Tears had filled his eyes and he said, “The cake was never for me, was it…” He understood for the first time that his birthday was an excuse for his foster mom to throw a party for her girls… at his expense. It is stating the obvious that this guy never experienced what it was to be truly loved; no real sense of belonging; at least not until he took all he could and ran off to chase it.
I asked my client if has ever felt loved. He replied, “Yes…” The first time he experienced the exchange of unconditional love was… when do you think? That’s right, “When I had my kid.” He looked into the eyes of his infant son and saw love in those eyes. He held his child and my client loved and was loved. Of course, he had no idea how the love he had for his son would be manifested through nurturing and provision, but he loved his son. That felt so good and so right that he did it again, with a daughter and another son. He did make money on the streets selling drugs and could put food on the table(s), and clothe them. Shelter was provided by the parents of his children’s mothers and grandmothers.
While knowing my client, he was unable to adequately provide for his children since he was in prison for the first time. Working through these revelations of how his life experiences have shaped his values, negatively impacting his moral standards, it was “normal” for him to justify a criminal lifestyle as relevant and essential to who he was as a man and father.
A Caucasian client of mine, as a young child, had hooks lodged into the skin of his upper back and was hung against a wall in the basement by his stepfather as “time out” punishment for his wrongdoings. Another client, ten to twelve years of age, helped his dad process trees into lumber. When the boy made mistakes, working the machinery at the mill, his biological father would intentionally allow a substantial chunk of tree to “jump” through the processor so that it would pop my client in the face who was receiving it at the other end. My early thirty-something year-old client showed me the scars.
There are so many horrific stories of physical and emotional abuse and torture that would turn your stomach as the stories turned mine. As a counselor, I offer to help my clients work through their misery through compassion, empathy, and understanding without myself feeling their pain. Emotionally, I have to maintain some sort of distance emotionally, or at some point it’s just to much. Some of these folks carry such bitterness and feelings vengeance against their fathers that they have murderous thoughts they have to process in order to move on before they are released from prison.
How do they move on? How do they let go?
On my drive in to work each day at the prison, I drove past a grade school. Often times there were children playing outside during recess. These kids still had their innocence. Just a mile or two away from this school were some two thousand boys the size of grown men who have lost their innocence; many of whom have also robbed other boys and girls of their innocence as well. The men at the prison were once “innocent” in their lives just as these children are.
These days, my professional life involves counseling God’s kids in a behavioral (mental) health setting. I am so, so… so impressed with the depth of insight of these adolescent and pre-adolescent children. Blown away! These kids can be incredibly descriptive of the confusion and turmoil in their lives impacting their experience within their families and other important relationships; all the while, feeding into the debilitating dysfunction that has promoted behavioral choices that come with them the potential for severe harm and even grave consequences.
I wish I could be much more specific about the stories of these kids and how they process from real tragedy to substantive recovery. Strict adherence to confidentiality prohibits me from doing so. Even though I would not mention names, the integrity of the process would be betrayed. (What does not compromise the ethics around confidentiality is what I say to patients. I will be sharing here what I have shared to some that I serve.)
What I will say is that the commonality of self-injurers, whether male or female, is consistent with what you may have already read somewhere. Young people that do harm to themselves, do so because feeling pain is necessary to feeling something when they have distanced themselves from their pain to the point of feeling numb or “indifferent”.
You might say, how does one feel indifferent, since indifference would suggest not feeling anything? To feel indifferent (maybe a better word here is apathetic but I have my reasons for not using it) does not at all mean that the pain has gone away, or been eliminated, it means that the mind play that goes on between thoughts and feelings is the arduous task of suppressing—burying—pain and sorrow, and perceived guilt and shame. It is the person’s attempt to lay down the burden of his or her reality.
Unfortunately, the suppression of one’s reality is not possible. It is mind play that rears its ugly head in other forms; namely thoughts of self-harm and suicide. The suppression of pain can manifest itself through self-injury. Which hurts worse, the burden of a life consumed by failed expectations across the spectrum of one’s existence, or cutting into one’s skin on the arm or thigh?
I recognize this is not exclusive to young people. These kids will in fact grow up. Left untreated, the patterns will continue. Perhaps, they come to find that they can suppress the pain and struggle of their reality through alcohol, drugs, and harmful interactions with others.
Working at the hospital, I have the opportunity to work with these kids while they are young enough to see their life in the world in a new light. I am able to listen to them share their life experiences, and their deep thoughts and feelings relating to those life experiences.
Your adversary the devil walks about like a roaring lion, seeking whom he may devour. 1 Peter 5:8 (NKJV)
Just yesterday, a teenage girl was talking about the circumstances in her life that seemed to feed into feelings of self-harm and suicide. She also talked about her experience of being depressed. We discussed the difference between feeling depressed and being depressed.
Let’s begin with Merriam-Webster’s definition of the word depress…
- to make (someone) feel sad : to make (someone) depressed
- to decrease the activity or strength of (something)
- to press (something) down
- to cause to sink to a lower position
- sadden; discourage
- Depressed mood, such as feeling sad, empty or tearful (in children and teens, depressed mood can appear as constant irritability)
- Significantly reduced interest or feeling no pleasure in all or most activities
- Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected)
- Insomnia or increased desire to sleep
- Either restlessness or slowed behavior that can be observed by others
- Fatigue or loss of energy
- Feelings of worthlessness, or excessive or inappropriate guilt
- Trouble making decisions, or trouble thinking or concentrating
- Recurrent thoughts of death or suicide, or a suicide attempt
Your symptoms must be severe enough to cause noticeable problems in relationships with others or in day-to-day activities, such as work, school or social activities. Symptoms may be based on your own feelings or on the observations of someone else.
Okay, now back to the teenage girl I was working with yesterday. She knows in her cognitive experience what it is to feel depressed. She may feel overwhelmed by her circumstances and the constant reality of failed expectations in her life. There are essential relationships that feel impossible to navigate. She feels unable to manage her emotions when those who love her seem incapable of adequately loving her; those whose role it is to nurture but whose behavior is so often counter-productive when it comes to nurturing. This is common to so many of our patients.
Then there is the family dysfunction that may or may not include alcohol and drug use. There is the dysfunction incurred by paternal relationships that are a mess; loaded with anger (and rage), resentment, jealousy, suspicion, entitlement, vengeance, and intense immature interaction that is so obviously harmful to one another, intensifying anxiety and overall discomfort for everyone in its wake.
Another intense reality in the experience of young people is that they are too often rejected by their peers and bullied. As a pre-teen, I myself was bullied by a bigger kid in junior high school. I will never forget going to school at the very least anxious, and at most, terrified. Being bullied is the one of the most distressful experiences anyone will endure in their lifetime.
My youngest brother (twelve years my junior) was chased home from school on a daily basis in seventh and eight grade. He had grown up by the time I heard his story. By the time he was a freshman in high school, something changed in him. He had a friend. His friend was confident. His friend was also a bit of an “outcast”. They grew in confidence together and acted out against social norms and expectations. My brother came home one day with a VCR he said his friend had given him. It turned out his friend had given my brother a few more nice things. My mother grew suspicious at the time and went through my fourteen-year-old brother’s stuff in the basement where he had crafted a bedroom. My mom found credit cards and purses down there. My brother and his angry-at-the-world friend had a little crime spree going on.
Many of the problems these young people face are kept secret. They are angry. They are lonely. They isolate. They alienate. (I explain to patients that to isolate is to pull away, while to alienate is to push away; the latter being even more alarming to parents.) They resist affection. They alone carry the weight of the burden. They carry the weight of family dysfunction, academic pressures, social pressures, the weight of rejection and betrayal, the weight of their physical features they perceive do not measure up to the expectations of their classmates and friends. They have to endure parents not really listening to them until it’s “too late” and their distress is severe.
So what is there left to do? What are the alternatives? And, what about when their issues are not only emotional and behavioral in their scope, but also there is neurochemical imbalance that may be the onset of some form of mental illness? What then?
The kids want off the ride. It is spinning out of control and they are so dizzy that they cannot make sense of it. So they do whatever they have to do to survive. Maybe they act out in ways deemed inappropriate and unacceptable by society. Maybe they turn to smoking and drinking. Maybe they self-injure, cutting in places that may be undetectable until they are wearing long sleeves on the hottest of days, sparking some curiosity from parents and teachers. Maybe they find access to alcohol and/or pills, skimming out of medicine cabinets or buying from dealers at school.
Some of these kids seriously consider suicide as an option. They are not thinking about anything else except finding another road seemingly less treacherous than the road they are on. They typically do not think of anything that may come after ending their pain and struggle (afterlife kinds of things). Suicide is the answer to making it stop. It feels like the only thing they can control. And if there is undiagnosed and/or untreated mental illness, these kids might just have the gumption to go through with it.
It is solely an emotional decision utterly betraying their rational intelligence, defying their core sensibilities and values. They are completely unaware of the neurochemical reality within the systemic processes of their brains that feed an irrational belief that suicide is a logical remedy for indescribable discomfort. The irrational belief fuels feelings and thoughts that then drive aberrant behavior, leading to an unimaginable outcome.
Since their parents tend not to be clued in to their child’s troubles, liquor cabinets are unlocked, medicine cabinets are unguarded, and their teenagers have access to whatever means necessary, sometimes including fire arms and ammunition. And when their child is feeling overwhelmed, like something’s got to give, it happens. The worst thing that can happen.
Hopefully, the teen in despair says something to someone, or in some way gives it away that they intend to harm themselves. They may not want to die, they just want the pain to stop. So they might send up smoke signals up of some kind. The tragedy is when young people who are suicidal are putting clues out there, but their loved ones are too caught up in their own dysfunction and distress to even notice.
Back to Her
As this teenager I’ve been counseling shared her story, along with her serious interest and commitment to the process of being able to manage effectively and productively, I was struck by her poise and maturity at such a young age. She so adequately articulated her role in the family dynamic and the condition of her paternal relationships. Through conversation, she identified applicable actions steps to what she can do to promote her recovery, understanding that her recovery is hers alone. She has internalized the nurturing inadequacies of those entrusted to nurture her, and has taken it on as her failure; a burden so heavy that she is buried under its rubble. The only way out from under its weight is… that’s when the thoughts of self-harm and suicide come into play.
This girl will tell you that she does NOT want to die. She loves living. There is so much in life to live for. But she is in fact still a kid that cannot escape the weight that has pressed her down to the point that it MUST be lifted. It is crushing her!
I remember in gym class as a kid having to run, and run, and run some more. The point of the exercise was to learn endurance, but as a child I didn’t understand that; nor did I care. I just knew when I couldn’t take another step and felt I would collapse.
As an adult, when I was hospitalized because of prolonged pain and tightness in my chest, a stress test for my heart required that I run up a hill at quite a brisk pace on a treadmill. The incline kept climbing steeper and steeper. I thought, “This is killing me!” I couldn’t take it anymore… not another step, and I yelled at the hospital staff to turn it off before I gave up and collapsed. I didn’t want to die. I just wanted—needed—desperately off the treadmill. If the treadmill wasn’t turned off, I was going to let go of what I felt was killing me and whatever happens after that, happens.
It turns out that most of these kids just want off the treadmill. It’s not that they want to die, it’s that they need out from under the weight of the burden they carry. They take on the responsibility for guilt and shame that isn’t theirs. Much of it is put on them by people who love them but don’t know how to love them. Failed expectations are killing them and the only way they know to let go is to give up… and whatever happens after that, happens.
So many of the parents of these kids are products of the same mess, themselves carrying the burden of a lifetime of failed expectations and undeserved guilt and shame that so often leads to deserved guilt and shame due to their own behavioral issues over the years. Now their children are paying for it, just like they did. And so it goes on… the cycle continues.
The work with the teenage girl I’ve been referring to is the kind of work that is helping these kids to identify all of which they cannot control, no matter how hard they try. Once they have connected their inability to move an immovable object to the suppression of pain that has produced suicidal thoughts, they can begin the process of letting go (in healthier ways) of what they cannot control. They can develop realistic coping skills that can be applied to the process of letting go in practical ways that make real sense to them.
We also talked about the cognitive mind play between thoughts of suicide and feelings of suicide. We talked about the difference between what she knows and what she feels, and how the mind play between the two affects her thoughts and feelings.
I kept thinking, this is way over her head. But as we talked, she would tell me how this mind play is specific to her so I am certain she was comprehending it. I’ve got to tell you, I was impressed.
I spoke of what she knows intellectually that makes all the sense in the world to her. She was able to talk about what makes sense to her about what she values and loves about life. But then, when she internalizes the flaws and failures of the nurturers in her life (not exclusive to parents), and then finds fault with herself for the dysfunction all around her that adds to her own feelings of inadequacy and failure, the pace and steep incline is too much for her and she wants to get off; the weight of the burden she feels is so so heavy and it is crushing her. She feels she must get out from under it. Suicide feels like the only alternative to alleviating her pain.
Her feelings then go rogue and betray what she knows intellectually. This betrayal can then lead to something perceived (perhaps even by her) as a suicide attempt; or there is talk of suicidal thoughts, or a note or journal that is read about suicidal thoughts that might even include a plan. Now she is hospitalized for major depressive disorder with suicidal ideation. While in treatment, the focus is placed back onto what she knows and believes (values) intellectually. Coping mechanisms are learned and developed to confront and combat emotionally driven values crying out for escape and relief; doing whatever it takes to “survive” the pain; even if it means ending the pain… assuming that suicide would indeed end the pain. (How do they know what is on the other side of successful suicide… escaping from what into what?)
It is amazing to me the ability of teenagers and even pre-teens to comprehend and understand this stuff. I suppose living in and through the mess of a life consumed by unmet expectations producing so much feeling of internalized inadequacy and failure will do it. These kids have a keen understanding of pain and how desperate they are to make it stop.
The other reality I discussed with this teenager about depression is an imbalance of stuff (chemicals) in the brain that promote emotional instability. We talked about how it is that people diagnosed with clinical depression, experience symptoms and don’t seem to understand why. People with depressive disorders may report that they don’t feel depressed in a sad way but they can’t stop crying. People with depressive disorders tend to feel listless; not sleepy necessarily, but as if they have no energy to do anything, or even move in some cases.
There is no stigma for someone diagnosed as clinically depressed taking medication to manage depressive symptoms. The medicine does not cure the disorder. Medicine for depression is not a crutch to avoid addressing feelings. Medicine helps to curtail harmful thoughts associated with the depression. Medicine for a cold does not cure the cold but is intended to curtail symptoms of the cold.
I spoke to her regarding my allergy symptoms. I do not know what is going on in my brain that when I get around dust that I cannot see, I experience sinus congestion, runny nose, and begin sneezing. I told her that I take allergy medication two or three times a day, whether I experience symptoms or not; that the medicine regulates the imbalance of stuff in my brain that produces symptoms. The medication stabilizes my symptoms and I can go through my day without the symptoms of my allergies taking over and ruining it. Diabetics take insulin to regulate their sugar levels, remedy imbalance, and manage symptoms of diabetes. The same is true for psychiatric medications to regulate imbalances in the brain to minimize and manage emotional (psychiatric) instability.
She liked that… thought it was pretty cool.
The transformative change that needs to occur for these kids isn’t that the thoughts of self-harm and suicide go away… even though that would be ideal… but rather that when these kids have thoughts of self-harm and suicide, they have the coping skills to manage their thoughts without acting on them through erratic behavior. When “relapse” prevention plans are developed and implemented, these kids are prepared for the feelings, thoughts, and impulses that they recognize as unhealthy and potentially harmful, applying their learned skills. Effective coping includes the support of others who are healthy, trustworthy, and equipped in some way to help them to resist the impulse to “go there” before it becomes something more powerful.
We educate our adolescent and pre-adolescent patients to sift through what is truth—affording them the resources to experience joy in their life—and the lies that seek to ravage their minds of all of the God-given virtue within them for genuine quality of life. To not give the lies power is to reject the premise that self-harm is an alternative to difficult and painful realities that have essentially owned the essence their souls, and stealing their opportunity for happiness.
Therefore submit to God. Resist the devil and he will flee from you. Draw near to God and He will draw near to you. James 4:7-8 (NKJV)
One of the critical points often made by these kids is the coping mechanism known as a refusal skill. When the thought or impulse of self-harm comes to mind, there is a kind of defiant cognitive rejection of the thought, necessary for resisting the impulse. What is needed in the heat of the moment is an alternative or substitution prepared in advance of the inclination toward self-harm.
It can involve reaching out to a trusted parent, or grandparent, or reliable sibling or trusted friend. It is someone who will listen without piling on to the misery of the one in need of support. It can involve a positive activity, or perhaps prayer.
Hopefully, it is someone at least somewhat informed concerning the experiences of the one reaching out in their suffering. It most certainly must be a hopeful person or people who are unconditionally empathic to the sufferer in need. It should be someone able and willing to listen to the stories of the sufferer without being shocked or overly troubled by what is being said. These teenagers will report events and describe feelings that at the outset sound alarming and frightening. It is imperative that the supporting listener does his or her best to be non-judgmental, which requires letting go of personal bias that has the potential for responses by the supporter contrary to what is best and most helpful for sufferer.
What the suffering teenager needs is to be empowered to have hope. They need resolution to the arguments they have in their minds about what is “wrong” with them. They need sound rationale for the extreme measures they might be considering to change their course. They need understanding about who and what they were created by God to be. They need to sensibly sort through the lies they have been defined by and discover real truth… the truth about life and how they are truly defined by whom they are made.
For though we walk in the flesh, we do not war according to the flesh. For the weapons of our warfare are not carnal but mighty in God for pulling down strongholds, casting down arguments and every high thing that exalts itself against the knowledge of God, bringing every thought into captivity to the obedience of Christ. 2 Corinthians 10:3-5 (NKJV)
The challenge is to communicate the truth of God’s Word, and the breadth of experience in relationship with Jesus Christ, in a way that penetrates and breaks through the lies borne out of their life experience, shaping the way they see themselves and the world in a life that is way too big and powerful and painful.
Transformed by a Renewed Mind
Seeds have been planted in the young people in infertile soil where ugly, gnarly weeds have prospered in their lives. Growing up and surviving in a culture of severe dysfunction has been normal to them. Many have survived events that fostered a lifestyle engulfed in guilt and shame; shame that has come to define them and, therefore, own them. (The same was true with the men I worked with in the correctional system.)
For godly sorrow produces repentance leading to salvation, not to be regretted; but the sorrow of the world produces death. 2 Corinthians 7:10 (NKJV)
Guilt is one thing. Healthy guilt can lead to repentance, redemption, and restoration. Healthy guilt is mindful of mistakes, learning from mistakes, making corrections and adjustments, and growing with renewed optimism moving forward. Synonyms for the word salvation are words like recovery and restoration.
Shame is the primary tool of the devil and everything ugly. Because, while guilt—associated with painful understanding—is a constructive learning and growing opportunity for positive, transformative change, shame is the fundamental weapon of destruction of everything righteous. Shame is the internalization of guilt that cruelly defines individuals and family systems.
While guilt admits to making mistakes from costly decisions, shame internalizes mistakes to the extent that is declares, “I am a mistake”… “I am bad”… “I am ugly”… “I’m unforgivable”… “I’m unlovable”… “I’m a failure”, and so it goes. Shame is the trapdoor into the pit of anguish and misery.
When I want to do what is right, I inevitably do what is wrong… There is another power within me that is at war with my mind. This power makes me a slave to the sin that is still within me. Oh, what a miserable person I am! Who will free me from this life that is dominated by sin and death? Romans 7:21, 23-24 (NLT)
“Progress means getting nearer to the place you want to be. And if you have taken a wrong turning, then to go forward does not get you any nearer. If you are on the wrong road, progress means doing an about-turn and walking back to the right road; and in that case the man who turns back soonest is the most progressive man.” —C.S. Lewis,
Have you ever been lost, and without a road map, the more you tried on your own to find your way, the more lost you became? You think that you’re getting back on track making this turn and that one. Then you realize you’re right back in the spot you were in when you were the most lost. Panic sets in. You start to sweat. There were times along the way when you could have asked for help, but you drove on without reaching out; which knowing this intensifies feelings of panic and crisis.
To determine to advance your course in the wrong direction is rooted in deception. Progress going the wrong way is leading to the opposite of where you truly want to be. To consider self-harm and suicide as a remedy for depression and pain will not get you closer to where you want to be, but rather take you further from it. Shame feeds into poor self-esteem and the prevailing sense of failure that is like a malignant disease that buoys feelings of defeat, emboldening irrational conclusions that suicide is the essential countermeasure for an ailing fatalistic existence. Shame is the bottomless pit into utter unworthiness and self-condemnation. And the ultimate act of self-condemnation is the act of suicide.
For God did not send His Son into the world to condemn the world, but that the world through Him might be saved. John 3:17 (NKJV)
Apostle Paul writes in his letter to the Romans concerning the battle within his mind; that there is this conflict of opposing desires and motivations. He concludes that there is something powerful beyond his control grabbing at the wheel, veering off the road, compelling him to alter his course. It is so powerful that Paul wrote that it leads him into harmful choices and behavior that prove costly if left untreated. To crash is inevitable. He said that the things he does are out of character and not what he really wants for his life. Paul even says that he is sick about it—miserable in fact. He goes on to write, “Thank God there is no condemnation in relationship with Christ Jesus.” (Read Romans 7:15-25)
So now there is no condemnation for those who belong to Christ Jesus. And because you belong to him, the power of the life-giving Spirit has freed you. Romans 8:1-2 (NLT)
“Because I am bad—because I am a disappointment— God has judged me and has punished me. My failures and inadequacies are proof that even God cannot love me. Therefore, I am not worthy of mercy. So then… tell me… what’s the point of going on?”
Even when a ‘sort-of’ rational thought might suggest that someone “will not love me”, which perhaps could have something to do with trustworthiness or any number of things, the irrational feeling is translated by shame to think and believe that “no one can love me… it’s not possible.” So, what is the key that unlocks the door to this cage? How do I overcome once believing the lies told by shame’s voice? Is it enough that I accept the favor of God’s compassion and mercy? What if I feel that it was for my sin that Jesus had to die, and that God had to sacrifice his only son… because of me? His blood is on my hands!
For if our heart condemns us, God is greater than our heart, and knows all things. 1 John 3:20 (NKJV)
I believe this passage to say that when anyone one of us struggles with feeling worthy of God’s mercy—in other words, believing the lie that we are unforgivable by God in our shame—that the Spirit of God knows this feeling in the hearts of His kids. God knows what the human spirit needs, not only to know that forgiveness is given, but that it must experience the compassionate mercy of the Savior. God gets it that His children are emotional creatures that need to feel forgiven to let go and live life as He intended it to be lived. The Spirit of God is our comforter. His grace is sufficient in our weakness.
Even if we feel guilty, God is greater than our feelings, and he knows everything. 1 John 3:20 (NLT)
God can and will cut right through our grieving souls and helps us to experience His mercy in our time of distress. He is so good like that; so kind. His touch is gentle while at the same time powerful to break through the walls erected from collective experiences that spawn distrust.
So many of the young people I work with have grown up in families that profess Christianity in the culture of religious structure, only to be abused and neglected in the systemic dysfunction in homes that are meant to be a refuge from all of the shots they take in the world. Instead of their home being a safe haven, it can be the source of considerable distress. Too often, these kids are shamed into feeling like worthless failures by mothers and fathers that attend church services on Sunday and make demands on them in the name of religion. Why would they believe it when someone tells them that God is for them? Where was God when these boys and girls were lost in their pain brought against them by loved ones laying claim to religious faith?
It is such a delicate thing to gauge the spiritual temperature of fragile teenagers considering suicide as their escape from pain and struggle and severe discomfort. One thing that I attempt to help these young people to realize that the way out of one thing is the way into another. It’s all about experiencing freedom. Anyone attempting suicide is in pursuit of freedom. But freedom from something or somewhere is freedom into something or somewhere; which may result in being less free and more bound than ever before.
Something the young people I treat tend to understand is that suicidal thoughts are the outcome of suicidal feelings; the need to get off the treadmill when they just cannot take another second of it. What I attempt to teach is the difference between a rational thought found in truth and an irrational thought rooted in lies. The way I describe it is that a rational thought comes from a sensible place that is intellectually reasoned as truth; where an irrational thought comes from an emotional place that is selfish and entitled on some level, and is typically rooted in the lies they have come to believe about themselves.
It’s awesome the depth of insight and understanding of these teenagers as they sort through the truth of what they know intellectually about their real life experiences and how what they feel emotionally, so often betrays what they know intellectually to be most sensible… reasonable… agreeable. When I am talking about this with patients who are nodding affirmatively to what they are hearing, and able to respond sensibly to what they are learning, I let them know that their agreement is the clear indicator of what they already knew to be true. It can be empowering to an adolescent to realize that it is already within them to process their experiences in order to develop realistic coping skills they can apply in the mire of internal conflict, when it matters most.
The Big Deal
The next tier of understanding is the reality of being transformed from something wrecked by hopelessness into the hope of being made new… a vessel restored; that something torn down, ripped apart and tarnished by lies into something ugly, is restored fully by truth into its originally intended beauty and wonder. This transformative, restorative work, is not of religion, but of relationship with Jesus Christ.
All we have to do is to let go just enough to be openly receptive to the restorative work of God; offering ourselves into the generous mercy of a loving Savior. We cannot on our own experience the transformative change necessary to experience the best of quality of life. It must be experienced in relationship with God.
In view of God’s mercy, offer your bodies as a living sacrifice, holy and pleasing to God—this is your true and proper worship. Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will. Romans 12:1-2 (NIV)
To BE transformed into something is the work of God. BE is a passive verb, meaning that it is something done to us and in us. All we do is offer our body sacrificially into the control of God who alone has the authority over all things. All we do is acknowledge to God the lure to worship the gods that are routinely worshiped in this age, so as to engage him in helping us to resist temptation. It is God that empowers us with the courage and strength and power to live in the best of what he wants and has for us.
How we are changed is by the renewing of our minds. The mind wounded by shame is convinced that the forgiveness of God is real and powerful. The mind shattered by neglect, abuse, betrayal, and abandonment is healed and restored. The mind, whose desires have been perverted, whose values have been distorted, whose morality has been diluted, whose memories have been held hostage by a life not really lived, has been rewired by the power of the living God.
Therefore, if anyone is in Christ, he is a new creation; old things have passed away; behold, all things have become new. 2 Corinthians 5:17 (NKJV)
I had the opportunity recently to counsel a teenage girl who had previously attempted suicide and self-injures; cutting her arms and legs. Self-injurers that cut themselves often say that they feel no pain when they cut. Or, they may tell you that they are numb, feeling nothing, and they cut themselves to actually feel something, since feeling some pain is superior to feeling nothing.
I ask patients why they self-injure, and am told that it is to make the sadness go away. Often times, patients do not understand what triggers such immense sadness. They are attractive, sociable, intelligent, enthusiastic, humble, kind, and really quite “normal” (whatever that even means). They require therapy, medication, and Jesus, if they will seek him.
When asking patients how sad they feel before they cut themselves, the response can be nine or ten on a scale of ten. When asked about their sadness level after they cut themselves, the response might five or six or seven out of ten. I suggest that lowering the sadness level by two or three points doesn’t seem like much. They usually agree… it’s not much; and it makes sense on a sensible, intellectually rational level, that it hardly seems worth it to mark up their body only to still feel quite sad. I asked one patient if it is like scratching an itch and she rubbed her fist against the inside of her arm and wrist where she cuts, as though she was scratching where she itches.
I discussed with a female patient coping skills as alternatives to self-injuring. She mentioned a few that help her for a little while but then don’t seem to be effective enough at resolving her sadness and depression. I introduced another option as an alternative to cutting. I asked her where she is spiritually. She comes from a religious family background that she is very unsure about. This girl, did acknowledge God as real but didn’t know much about him or his Son, Jesus.
I talked about Jesus as a historically documented person that really lived, and then died on a cross. When telling her what the Bible says about Jesus raising from the dead, I admitted that it is something far more difficult to prove or accept without faith. The point is that once accepting the reality of God as Creator of all things in the universe, particularly living things with the capacity to live and reason and love and heal, then all things are indeed possible after that. So, why not the resurrection of God’s son? With a childlike innocence regarding this possibility, she agreed with the premise.
“Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.” Matthew 11:28-30 (NIV)
Instead of telling her that God sent His son to her to die for her sin, I told her that God loved her so much that He sent His son to come to her to love her and die in order to take her pain from her. I did explain to her what is meant by “my yoke is easy” and how the apparatus of the yoke allows the strong to bear the burden of carry and pulling the heaviness of the weight to ease the burden of the weak.
BOOM!!! Wow, God is so good!
This teenager, recognizing that she has a wonderful life waiting to be lived if she can let go and lay down the burden that’s been weighing her down, became tearful as she was emotionally absorbed into this truth about God’s love; something her praying mother had also shared with her. I encouraged my patient to consider prayer to ask Jesus to be there for her and again she teared up with emotion and smiled real big. It was like something lifted as I witnessed her countenance light up. Her mood improved dramatically as she went about her day, even while in a hospital setting where this all took place.
Later that afternoon, as she walked with her mother and sister who’d been visiting, I said to them, “That’s quite a girl you have there. She’s special. She just needs to believe it.” The girl grinned from ear to ear.
Since so many of the kids I work with battle the feeling of giving up when overwhelmed by anxiety and stress, I share with them my personal experience when I thought I might be having a heart attack. For nine hours it felt as if something was squeezing my heart. I went to work and went through the entire day with chest pains and pressure in my chest. My wife, a nurse, was working the second shift until almost midnight so I chose not to bother her with it. I didn’t tell anybody.
After self-diagnosing online it made the most sense to venture to the emergency room at the local hospital. Once getting attention at the ER I was given a three-drug medication cocktail and the tightness and chest-pain was eradicated in right around ten minutes. It turns out is was a GI thing I was told was due to internal stress that mimicked a heart attack. However, I had another problem. When initially interviewed by medical personnel, I disclosed that my father died from an apparent heart attack. This meant that they would have to stress my heart enough to prognose it is as healthy enough to release me.
The clinical staff told me that, per protocol, they needed to get my heart beating to 160 beats a minute. So let the games begin, I suppose. They put me through some exercises to get my heart to race a bit and then put me on the treadmill. As they gradually sped up the treadmill to the point where I was running at a pretty brisk pace, my heart was beating in the neighborhood of 100-110 beats per minute. Not even close to the criteria that needed to be met. So they set the treadmill at a faster pace, and when that only brought my heart rate up slightly, they set the treadmill on an incline so that I was now galloping uphill.
After a couple of minutes of this, I began to really labor. The temperature in the room was quite chilly, yet I was sweating buckets. Sweat was dripping from everywhere and I had soaked through my scrubs. I felt my heart beating through my chest. I was to the point where I was completely drained of energy. I could not continue to do this. I was out of fuel and felt like I was going to collapse. I kept telling them, “I’m not kidding; I am going to fall.”
Can you remember riding your bicycle up a hill until you couldn’t pedal anymore, having lost the energy to keep pedaling. What did you do? Did you give up and fall to the ground? Or, did you get off your bike and walk it the rest of the way up the hill? Falling would be painful. It would probably be on face, and who knows what that experience would be with the treadmill ripping against my flesh.
By now, I no longer had the energy to even hold onto the handles anymore. I could also see the monitor that indicated my heart rate to range from 150-155 beats per minute. I could no longer stand it and I called out again, “I’m gonna fall!”
I screamed at them, “Turn it off!”
Good thing they lowered and slowed it down by increments. Had the treadmill just stopped, I would have run through the wall in front of me.
The treadmill was off and the staff helped me to a chair where I felt a tremendous sense of relief. My heart was still stressed and beating out of my chest but the worst of it was over.
I had felt absolutely overwhelmed and consumed by the stress of that experience, which lasted only a few minutes but felt like an eternity. I was utterly helpless and overcome to the point that I would have given up. But I did not want to die, and remained hopeful that if someone turned the treadmill off, I stood a chance. My life would be better.
I called out for help and received the help that I needed to manage.
I have shared this story with almost all of my teenage patients and many of the preteen children I have worked with. I then ask the following question.
“When you were feeling overwhelmed and considering suicide (and in many cases have attempted suicide), did you want to die, or did you need for someone to turn off the treadmill?”
Of the hundreds of adolescents, and in some cases adult patients, only one person said that he wanted to die. In virtually every case, these kids say that they need the treadmill turned off. Through this story, these people recognize that when they feel they are drained of energy and feel they have no choice but to give up, they are feeling helpless, rather than hopeless. It is of most importance… critical… life and death.
I shared that story with a young girl whose age was a single digit who told me she felt helpless and knew that she didn’t want to die as she held a knife to her chest in front of her mom and dad. When I asked her what holding a knife to her chest communicated to her parents about what she was feeling, this very young girl correctly indicated, “Hopeless.”
So many of these girls and boys that self-harm by cutting and using drugs do so, not because they are suicidal per se but to manage stress, communicate to loved ones and others paying attention (including psychiatrists), that they are in a place of hopeless despair, which is typically not the case. They are feeling desperately helpless but don’t know how to express that. They themselves are deceived by their feelings that they feel hopeless, to the point they feel they have no options left but to give up and die to experience the relief they so desperately need.
So it is essential to educate these kids concerning the fragile and unpredictable nature of brain chemistry. It is paramount that they discover how to filter raging, desperate emotions through rational, intellectual reasoning, according to what they already know makes the most sense, no matter the intensity of their real-life day-to day circumstances.
One thing to consider before getting to the point is this:
There is a distinction to be made between distress and despair. My experience working with, in particular, teenagers that self-injure is that usually they are not suicidal, even though they will report having suicidal thoughts. Upon further examination talking with patients, while they are in distress and feel as though they cannot take it anymore, they are desperate for change and reach out for help. They may even feel a sense of helplessness in their distress but remain hopeful when allowed to reason things out and make sense of their mess in terms of how to approach things and resolve problems and conflicts. They remain hopeful that with a plan to effectively cope, which can include medication and involve trustworthy support, they can once again feel healthy and be productive.
Despair is another matter entirely since it is the product of feeling hopeless, and no matter what they do, life is to heavy and painful and they are tired of living it. Brain chemistry crises can be at the center of the experience of clinical depression, which hatches the sincere desire to die (patients might not even know why they want to die).
The key is to recognize what is truly motivating feelings that induce thoughts of self-injury and harm. Is it distress that typically prompts the urge to cut superficially into the skin as a hopeful means of coping with the weight of their stress and anxiety, or is it despair that more typically involves more severe self-harm, carving deeper through the skin in areas of major arteries, and often is accompanied by a more lethal kind of suicide attempt, such as a drug overdose, threats to act out in ways that are more sudden, profound, and thorough, perhaps involving a firearm, stepping into traffic, jumping from dangerous height, hanging, drowning, and those kinds of things.
I am compelled to educate my teenage patients concerning this important distinction between distress and despair so that they can, first, comprehend and reason for themselves where they are at along this spectrum. Once they better recognize there condition, having more (intellectually) sensible understanding, then they can better articulate in their communication what they are feeling when they self-injure.
Since, according to research and now my own professional experience, I believe that self-injury is usually an unhealthy and potentially harmful (scars, infection) method of coping rather than what is typically perceived as suicidal behavior (though of course it can be at times a primer for a possible suicide attempt), I believe these young people that cut themselves need to learn that there are more effective means for coping with anxiety, stress, confusion, and depression. They also need to be able to have a more productive conversation (since they are minors) with others with influence and in authority that are making life-altering decisions (i.e., length of hospital stay) on their behalf.
They also need to be better and feel better about themselves. They are not weak-minded. They are not disappointments and failures. They are not so unusal, comparing themselves to those who over/under eat, and/or those that use alcohol and drugs, and/or those who turn to unhealthy relationships, etc., as coping methods to experience relief from discomfort.
So then, since we have a great High Priest who has entered heaven, Jesus the Son of God, let us hold firmly to what we believe. This High Priest of ours understands our weaknesses, for he faced all of the same testings we do, yet he did not sin. So let us come boldly to the throne of our gracious God. There we will receive his mercy, and we will find grace to help us when we need it most. Hebrews 4:14-16 (NLT)
They need to know that there is One who accepts them unconditionally and loves them like crazy. Someone who can ease their burden and has already absorbed their pain. Someone who will be a loving father, a trustworthy brother, and cherished friend to them because he knows them because he has been there. And because he’s been there, when they get lost, he knows the way out and will love them through their mess until they experience his love and are back on track.
5 For the more we suffer for Christ, the more God will shower us with his comfort through Christ. 6 Even when we are weighed down with troubles, it is for your comfort and salvation! For when we ourselves are comforted, we will certainly comfort you. Then you can patiently endure the same things we suffer… 9 In fact, we expected to die. But as a result, we stopped relying on ourselves and learned to rely only on God, who raises the dead. 10 And he did rescue us from mortal danger, and he will rescue us again. We have placed our confidence in him, and he will continue to rescue us. 2 Corinthians 1:5-6, 9-10 (NLT)
To be honest, I don’t really know how to finish this chapter. I suppose the point am I hoping to deliver is that the resolution to the drama in conflicts that our children face is in relationship with God through Jesus Christ. While that may be so obvious to you and me, the means to engaging in relationship with Christ is lost on so many who do not know him, and do not understand what it truly is to have relationship with the Creator of the universe. A young person can really get lost in attempting to comprehend the deeper truths that are central to their freedom from all of the pressure and stress that is inherent in being a child growing into adolescence, and then into adulthood.
I cannot really find the right words to finish this article, knowing that the work of helping these very young men and women is unfinished business. So many of them hurt so much, and many truly don’t know why. Then there are others living in so much dysfunction that feels so hopeless to them that they just want out.
Some really do feel like death is the answer.
For most of these kids, though, it’s not that they want to die. They just want off the treadmill.
“Someone, please turn it off because I can’t hold on any longer.”
“Please God, I need you… show up in my life… TODAY!”
I pray that God, the source of hope, will fill you completely with joy and peace because you trust in him. Then you will overflow with confident hope through the power of the Holy Spirit. Romans 15:13 (NLT)
The following video from the movie, Gimme Shelter, is an illustration representative of the kind of teenager treated in behavioral health facilities everywhere. The teenager’s parents were themselves teenagers when she was conceived. Her mother was a drug addict prostituting for drug money. It is the life she was born into and raised in. It turns out the teenager is herself pregnant and having run away from mom, seeks refuge anywhere else that isn’t “home”. The girl is at some hospitalized and discovers it’s official that she is pregnant. The scene below is the confrontation that happens when her mother finally found her.