Life under Pressure: The Social Roots of Youth Suicide and What to Do About Them

What causes suicide clusters to form?  That’s the fundamental question behind Life under Pressure: The Social Roots of Youth Suicide and What to Do About Them.  The book follows a community known by the pseudonym of “Poplar Grove.”  It recounts stories and quotes from interviews to understand what has made Poplar Grove such a hot spot for youth suicide – and what can be done about it.

Clustering

Usually, a suicide cluster is two deaths plus an attempt or three deaths in a short period of time in a constrained geographic region.  The real question is what causes them and what can be done to prevent them.  There are several factors that lessen the barrier to suicide for those exposed to one.  First, suicide is brought to mind as an option that may have never been considered before.  Second, the death of someone close necessarily causes grief – and that makes life seem a little less worth living.

But not every suicide death (or any death, for that matter) sets off a suicide cluster – far from it.  While suicide clusters aren’t frequent, they are painful for the people who are left behind and communities they occur in.  Understanding what conditions create or allow clusters to form allows us to design interventions to prevent them – at least in theory.

The Setup

Life under Pressure is a bit repetitive.  It focuses attention to the intense performance pressure and dense social ties of a “must-be-seen as” community as the contributing factors that led to so many youths deciding that death looked better than life.  (See Leadership and Self-Deception for more about “must-be-seen-as.”)

Performance Pressure

Some communities value educational and professional attainment to a degree that they place pressure on their children to be the best, to be involved, and to not show faults.  (See The Years that Matter Most, which was later republished as The Inequality Machine: How College Divides Us, for more.)  The result is that we’ve developed youth with greater anxiety and perfectionism.  (See Perfectionism for more on what it is.)

To be fair, this pressure provides growth opportunities that are needed.  (See Antifragile.)  It can even be argued that peak performers need some degree of pressure.  (See Peak.)  The problem is that this community didn’t create the kind of “air bags” that Robert Putnam describes in Our Kids.  (See also Putnam’s Bowling Alone for background.)

Parents and community members said they were available for youth that needed help – but the youth didn’t believe it, or at least didn’t use it.  They didn’t believe that they were psychologically safe enough to share.  (See The Fearless Organization for more on psychological safety.)  They also didn’t believe that others would or could help.

Dense Social Ties

Generally, we speak of connectedness and social capital in a positive way.  It has protective factors.  (See Analyzing the Social Web for a technical analysis of social ties.)  However, as Richard Hackman explains in Collaborative Intelligence, sometimes teams (his context) have connections and boundaries that are so rigid that they inhibit growth and results.  From Jesuits (see Heroic Leadership) to economics (see Trust), ethics (see How Good People Make Tough Choices), and sociology (see Delinquent Boys), we’ve learned that rigid cultural control of people can have negative consequences, and it sometimes takes real skill to avoid getting wrapped up in them.

Everyone knows everyone else’s business.  That’s the problem.  High performance expectations and dense social ties means that if you admit to a challenge, a limitation, or a fault, everyone will know it in an instant.  This is the driver that makes psychological safety so hard.

Everyone knows that if they admit a problem, everyone will know – and everyone will judge them for it.  Maybe they’ll be overt about it, or maybe they’ll be silent.

Community Pride

There’s a shared ethos of pride and expectations in the community.  They’re all there because the parents wanted to give their children the best chances to succeed.  They’re into athletic excellence as well as academic excellence.  The parents made it far enough in their lives and careers to make it possible for their children to grow up with good schools and support.  They never thought that it would lead to so many with anxiety and so many of their children considering or attempting suicide.  They never saw it coming.

Warning Signs

While the repetitiveness of the book can be frustrating, it’s nothing compared to the promotion of falsehoods.  It says, “To correct another myth, we should address the belief that suicide rarely occurs without warning. There are almost always warning signs. Unfortunately, our society is not very good at recognizing those warning signs and intervening.”  First, if they were dispelling a myth, one would think they’d offer evidence, but no evidence is offered.  Instead, the authors push forward a statement that isn’t based in fact – and is problematic on multiple levels.

The argument is often that, in retrospect, people identify signs.  There are two fundamental problems with this.  First, they’ll claim to see signs that were never present.  Recall-based approaches have been proven faulty repeatedly.  There’s no way to say that what they recall actually happened.  Second, and more importantly, these signs don’t have any predictive value.  Often warning signs include “behavior change.”  The problem is that people change their behaviors all the time – and a vanishingly small number of people are going to attempt suicide because of it.

I have 3+1 signs.  The 3 signs are when they say, “I’m going to die/kill myself/suicide,” “(It doesn’t matter) I’m not going to be here anyway,” and “I want to give you this (prized possession) because I know you like it.”  The +1 is sleep disturbances.  For the first three, we’ve got a clear message we can and should respond to.  For the +1, it’s a reason to check in – and continue checking in.  Sleep challenges lead to cognitive challenges – and cognitive constriction, which can be dangerous.

I’m not suggesting we can’t start a conversation about suicide when we see one of the signs on the numerous “warning signs” lists.  I’m saying we should be starting a conversation about suicide without them.  The warning signs just aren’t predictive of risk in an individual.

The problem isn’t “recognizing.”  The problem is that we’ve included so many signs that they’re meaningless.  If you don’t believe me, you’ll find the evidence at Myth: Every Suicide Attempt Has Warning Signs.  (Direct journal articles and research are linked from this page.)

No Mulligans

In golf, a mulligan is an attempt to do the same shot again.  Live doesn’t have mulligans, but too many parents treat their children like their own personal mulligans.  If they didn’t get the starring role in the high school or college play, their child surely will.  They missed out on an athletic scholarship to college, certainly that won’t happen with their child.  Whatever dream they missed, their child won’t.

The problem is that life isn’t designed to work this way.  They get their shot – and their children should get theirs.  If they force their will on their children, both the parent and the child tend to be disappointed, frustrated, angry, and confused.  It’s not healthy – but it’s something that I see all too often.

School Responses

The school in Poplar Grove was criticized for their responses.  However, even the guide, “After a Suicide: A Toolkit for Schools,” from which the authors draw their perspective isn’t perfect.  There are simple things like treating all deaths the same and ensuring that the suicide isn’t glamorized.  However, as you dig into the guide, you’ll find an inappropriate coupling of mental health to suicide, implying or directly stating that this should be a part of messaging to parents and students.  There is no research support for this approach – and it necessarily further couples and stigmatizes both.

While insisting that all deaths should be handled the same – and they should – the guide continues to prescribe different messaging and approaches for suicide.  The guide itself (and the authors of this book) are inadvertently doing the very thing they’re telling others not to do.

Shaky Ground

Qualitative research is very difficult to get right, and often it suffers from biases.  The questions that are asked (even in structured interviews) are often driven by the perspective of the interviewer.  That’s just a part of the process as we move from qualitative to quantitative research.  However, one can practically hear the rumblings, as statements like, “we are fairly convinced that large, well-attended memorials have unintended negative mental health consequences,” clearly reflect the bias of the authors (as indicated) – but no proof or theory is offered to support these type of statements.

While I can appreciate the delicate nature of interacting with a community in the midst of a suicide cluster, I cannot fathom statements like, “We did not feel it was appropriate for us to attend any of these memorial services or vigils ourselves, so we cannot provide an observational account.”  I liken it to the person who records a video of someone else getting injured rather than rendering assistance.  I see no reason why someone researching how to prevent more death can’t approach an official to ask for permission to listen to the service.  It strikes me that this decision might be based more in fear of the awkward conversation. “How did you know the deceased?”  The answer is simple.  “I didn’t, but I want to prevent others from dying like they did so I’m here to learn from family and friends.  I hope to learn more about him/her.”

There is some good to be learned from pressure.  However, it’s not right to have an entire Life under Pressure.