Dr. Steve Gerali: To Save a Life

Overlapping with National Suicide Prevention Week this year is National TO SAVE A LIFE WEEK (September 6 - 12), which encourages churches, parents and teens to start the new school year looking at the issues of teen suicide, bullying, depression, body image, etc., and to start the conversation to let teens know they are not alone -- that help is available. To better understand the issues of teenage depression and suicide, we talked this week to Dr. Steve Gerali, author of What Do I Do When Teenagers are Depressed and Consider Suicide?, as well as a host of other publications focused on understanding the problems of adolescents.

As regards suicide prevention, let's open with the classic question of Cain: Are we our brothers' keepers?

That's a great question. In the light of suicide, yes, we are -- especially with teenagers. What happens with teenagers is they tend to get into a depressive state that spirals out of control to the point where they make some very irrational decisions, because they may not have the cognitive wherewithal or the coping skills to handle some of the things that they're going through. So suicide becomes an option, and then because of the aggressive nature of adolescence, they also have the means to carry out their suicide plans.

So in that aspect, yes, we need to be watching kids.

When you talk about depressive states, are you talking about depression as a chemical imbalance in the brain or as a natural reaction (or overreaction) to life situations?

It's all of the above -- it's everything from chemical imbalance to faulty thinking, how a kid processes the things that are going on around him. Sad is sad, regardless of how we get to that end, and with a teenager the coping mechanisms may not be there, so they can do some very irrational thigs.

In your book, What Do I Do When Teenagers are Depressed and Consider Suicide? -- one of your many books for youth pastors and people who work with teens -- you address the phenomenon of 'cluster suicides.' Can you explain for our readers what that is?

Cluster suicide is a phenomenon that occurs when a teenager in a community or in a school commits suicide, and then all of a sudden there is an epidemics of attempts -- and maybe completed -- suicides.

What happens in the phenomenology is that students begin to watch what occurs -- they watch how sad people become, they watch the attention that's directed to the teenager that's deceased and to their family -- and they start fantasizing about death, and about their problems, and about how they should cope with that. On top of that, it gives rise to grief that's not directed and not worked through, and so these kids end up attempting -- and sometimes completing -- suicide. So whenever a suicide occurs in a community, it's essential that teenagers who are at risk -- those who are sad, those who are angry, those who have poor coping skills -- are watched.

You also talk about the correlation of suicide to students coping with being gay or being bullied or otherwise feeling like an outsider. Is that a real driving force behind teen suicides, or is there usually something else at work?

I wouldn't say that it's the driving force behind teen suicides, but in some cases this becomes a very, very prominent risk indicator -- especially with bullied kids. We saw a few years back an epidemic of kids that would go into schools and they'd start shooting and being very aggressive. The problem there was that these were kids that were bullied, and what happens is that they enter into suicide ideation, and the plan includes then homicide. So they go in, and they feel trapped , they feel helpless, they feel terrorized, and the only solution that they know out of that is death -- and many times they decide they're going to take out a few people when they commit suicide themselves.

With teenagers who struggle with homosexuality, we can even put this in the same category right now with teenagers who struggle with the effects of a spiral-down economy; they watch families losing jobs, and it breeds a hopelessness that they're not going to fit in society. And they don't have the coping skills to move beyond that. As a result of that, suicide becomes an option to them.

It plays into the depression. It's a different kind of a depression, because it's a depression that is pronounced more by situational hopelessness.

What role does social networking play today in teen depression? Does it exacerbate the problem, or give it greater exposure?

Cyber-bullying is a big problem right now. In a situation where kids talk about another kid, the words are said and done. In a situation where it's cyber, what happens there is that it's long-lasting. It stays online for a long time.

And it's not just online. What happens is kids mass-emailing and mass-text messaging, which becomes a situation that gives greater exposure to lies and slander that a kid experiences. And it gives long-lasting exposure, so, again, what happens is kids who are cyber-bullied tend to see this as a hopeless situation -- no matter where they go, they can't escape it because it's online. So suicide becomes a means to escape it.

Does literature play any part with today's teen depression and suicide? The popular genre right now is vampire literature, where people may have a sad life but beyond death there appears to be a better life where I'm powerful and attractive.

We would be ignorant to say that it doesn't. But we would also be ignorant to say that that's the only thing that plays into that with teenagers. Teenagers are highly influenced -- they're very susceptible, and they're in a stage in their lifespan where they're forming identity and they're forming coping mechanisms. So when they begin to see faulty ways to cope -- through media, through their home environment, through the conversations they have with their friends, and the list can go on and on -- when they start to process that, yes, it does become a part of the way that they respond.

So there is evidence that tells us, yes, media stuff -- movies, television, all that -- influences kids. Obviously we wouldn't advertise if it didn't. But on the other hand, to say that that's the sole influence, and to attack that as the single source, is probably just as ignorant.

You do a lot of work with Christian teens through church youth programs. Can you explain how Christianity and the science of psychology mesh up, especially in a society where many would say you're supplanting critical thinking with a "religious fiction."

I think that all truth is God's truth, whether it's the truth of science or the truth of the Bible. And there are some conclusions that we come to. For example, when we're dealing with a teenager who is suicidal, whether we're Christian or Islamic or Buddhist, the primary objective is to keep this kid alive. And I think that's going to be a critical starting point. I often the pushback is not from people who are not Christian in this situation, the pushback is from people who are Christian; they don't want somebodyw ho has any kind of psychological background, who is not a Christian, talking to their kids or helping their kids. That's where I say we're going to start at the same place, and that's trying to keep this kid alive. And so the mechanisms that we have -- the science that we have -- to do that is that is the same whether we're Christians or not.

Now, ultimately, when we start to teach coping skills, there may be some things that we share that are moral; there may be some things that we share in the name of what is good. But when we start to talk about the things that we share that are faith-based, faith-formative, that's where we start to differ. So at that point, I'd say the coping part of things, helping a kid cope, Christians tend to talk about the fact that hope comes in Jesus Christ. So that would be the formative faith part of the coping mechanism.

What can a person do if they know a teen who is at risk of something like this, and they don't feel prepared to confront the situation head-on -- maybe it's not their child, or it's an unsourced anonymous video online?

I tell people to always take the verbal expression of suicide seriously with teenagers. That's the first thing -- don't underestimate it. The second thing that I would say is that it's really important that this not be kept confidential, and we need to tell our teenagers this. If a friend says to our teenagers, "I'm thinking about killing myself," or, "It would be better if I weren't born," or something like that, then they need to be talking about that with adults who care.

An adult who thinks this, the thing that I say they need to do is notify parents, first of all. Notify people in authority who are in caring roles around that kid -- teachers, coaches, youth workers. Those are the people they should notify, and then they need to get help.

Now, if this is really severe, and the kid is online and they're talking about suicide and they have a weapon or means to commit suicide, notify the police. Police can do an intervention and can get this kid into a place where they can get some significant help.