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Section 25
Suicide: Impact on Children

Question 25 | Test | Table of Contents

Proceeding beyond such indications of children's involvement in parental suicide, the study presented in this first section of the paper represents an initial clinical exploration of the psychological impact of parent suicide upon children. It is based on the case materials of forty-live disturbed children, all of whom had one parent who had committed suicide. The children, ranging in age from four- to fourteen-years-old, had almost all been seen for diagnostic evaluation and/or treatment in child guidance settings. The materials of the study consisted of the typical data from outpatient evaluations (usually though not always including a developmental history, psychiatric interviews, diagnostic testing, and referral materials), plus therapy notes from outpatient treatment if initiated, and in nine cases the additional materials from inpatient treatment.

The children ranged widely in the severity of their psychopathology, from relatively mild neurotic conditions to psychoses. What is most striking is that even with conservative diagnostic assessment, eleven of the forty-five children must be considered unquestionably psychotic (as compared with only four psychoses in a roughly comparable non-suicide group of forty-five childhood bereavement cases). Whether contrasted with childhood psychosis incidence figures from the general population or from the Children's Psychiatric Hospital where the majority of these children were seen, the incidence of psychotic conditions in this parent suicide group was many times that of the more general group of disturbed children-a tribute not only to the impact of the suicide but of course also to the pathological pre-suicide family background.

The symptom pictures of the children covered a broad spectrum, including psychosomatic disorders, learning disabilities, obesity, running away, tics, delinquency, sleepwalking, firesetting, fetishism, and encopresis, along with characterological problems, classical neurotic disorders and psychotic conditions. Perhaps the most meaningful division of these children into clinical subgroups would include two major groups, composing approximately 60 percent of the total sample: those children whose disorders were of a minimally veiled depressive nature-typically sad, guilt-laden, withdrawn, fearful, inhibited children-and those with more alloplastic object-loss reactions, especially seen in the more angry, truculent, defiant child, whose plentiful aggressive behavior often seemed poorly organized and almost objectless in nature.

Turning from a brief, necessarily sketchy characterization of the sample, this portion of the report deals exclusively with two crucial facets of disturbed reactions to parent suicide: (1) the role of guilt and (2) distortions of communication. While the forms of these distortions varied considerably, dependent upon a myriad of factors (preexistent personality of child and surviving parent, nature of the suicide and the child's relationship to it, the child's age, etc.), their presence was pervasive and often quite blatant.

The child's guilts related to his parent's suicide were generally so intense that the superego distortions were readily visible in the child's psychopathology: overt in open, even insistent statements of guilt and self-recrimination, or prominent in a wide variety of pathological forms including depression, masochistic character formations, guilt-laden obsessive ideation, character structures based on rebellion against an externalized superego, rampant self-destructiveness, and reaction-formated suffocating passivity, inhibition, undoing, and ultra-goodness.

Particularly striking were the multiple sources and foci of these guilts. In part, they inevitably derived from typical preexisting sources of hostile wishes toward the suicidal parent, these hostile impulses and fantasies being seen as fulfilled by and responsible for the parent's death. Such hostile wishes stemmed from customary sources in parent-child interaction, varied from totally unconscious to quite open anger and in some instances had been unfortunately heightened just prior to the suicide by otherwise transient resentments such as a refusal to give the child a two-wheeler bicycle. But quite aside from these typical sources of children's guilt in the face of parent loss, there were numerous special wellsprings. Where the parent's suicide was the outgrowth of a long-standing depressive character structure or condition, the depressive parent often had long exercised his expertise at making his children (as well as his spouse) feel guilty about and partially responsible for his sadness and despair-all the more so, then, for his suicide. Where the parent had been severely disturbed, especially in borderline or highly agitated conditions, often the child had been told, warned and scolded by his other parent or the family physician that he was "upsetting Mom," that he was "driving her crazy," that he must be very quiet, be very good, mustn't argue or upset her "even if she does do funny things sometimes," placing a large burden of responsibility on the child. Even more devastating were those cases where the parent's repeated histrionic suicide threats and gestures had eventually driven the frightened but increasingly exasperated child to the point of consciously angrily wishing that the parent would "go ahead and do it."

Aside from specific incidents prior to the suicide, the children often felt they were primarily responsible for the general background events and feelings that led to the suicide. That is, the child was convinced it was his basic badness or his father's disappointment in him that bred unhappiness and ultimately suicide; or he blamed himself for a good share of the marriage difficulties, for consistently siding against the suicidal parent in arguments, for "costing too much" amidst financial troubles, and he especially recalled parental arguments about himself.

Another constellation of guilts frequently encountered centered around the suicidal act. These children felt they should have stopped it, should have saved their parents somehow. Some plagued themselves with feeling it would not have happened if they had only been home instead of at camp or at the playground or at a friend's house. Others fiercely condemned themselves for not having told someone about previous suicidal attempts, or preparations for the suicide. In some instances the children had not initially understood what they saw of earlier attempts or preparations, or were too frightened to talk about them, or had been sworn to secrecy, or were rebuffed before when they tried to tell. Particularly guilt-inducing were those instances where the child had been asked to watch over a potentially suicidal parent, to "call daddy right away at the office if mommy seems real upset," or "make sure you watch and go with her if she goes down into the basement." This enormous burden was transformed into equally intense guilt when the child failed to warn of or stop the suicide. Similarly, some children found grounds for blaming themselves for not getting help soon enough-for not running quickly enough, not knowing who to call, not opening the windows or being able to drag their parent's body out of a gas-filled room. The ferocity of their guilt was fully evidenced by their absolute insistence-in the face of therapists' interpretations and reality confrontations-that it was their fault.
- Shneidman, Edwin, Comprehending Suicide: Landmarks in 20th-Century Suicidology, American Psychological Association: Washington DC, 2001.

Update
Prevalence and Correlates of Suicide
and Nonsuicidal Self-injury in Children:
A Systematic Review and Meta-Analysis

- Liu, R. T., Walsh, R. F. L., Sheehan, A. E., Cheek, S. M., & Sanzari, C. M. (2022). Prevalence and Correlates of Suicide and Nonsuicidal Self-injury in Children: A Systematic Review and Meta-analysis. JAMA psychiatry, 79(7), 718–726.

Personal Reflection Exercise #10
The preceding section contained information about the impact on children of suicide victims. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
About mental health and suicide in children and adolescents

- Díez Suárez, A., José Carballo, J., & Sánchez-Pina, C. (2023). About mental health and suicide in children and adolescents. Anales de pediatria, 98(6), 488–489. https://doi.org/10.1016/j.anpede.2023.04.011

Peer-Reviewed Journal Article References:
Bartik, W. J., Maple, M., & McKay, K. (2020). Youth suicide bereavement and the continuum of risk. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(6), 483–489.

Lee, K.-Y., Li, C.-Y., Chang, K.-C., Lu, T.-H., & Chen, Y.-Y. (2018). Age at exposure to parental suicide and the subsequent risk of suicide in young people. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(1), 27–36.

Miklin, S., Mueller, A. S., Abrutyn, S., & Ordonez, K. (2019). What does it mean to be exposed to suicide?: Suicide exposure, suicide risk, and the importance of meaning-making. Social Science & Medicine, 233, 21–27.

QUESTION 25
How was the child's guilt related to his parents suicide readily visible? To select and enter your answer go to Test.