Originally published in The Medical Post, VOLUME 37, NO. 29, September 4, 2001

A 13-year-old girl erroneously believes her suicide will improve life for her eight-year-old brother

There are times when I encounter a patient who leaves a permanent, haunting impression on me. The situations that lead to such heart-wrenching memories can make it difficult to remain objective.
Melinda, not her real name, was 13 years old. Her guidance counsellor advised her to see me at our school clinic. There were concerns she was severely depressed and needed help. Earlier in the week, she had eaten about 30 Tylenol tablets. Her parents, aware of her actions, did nothing. According to the guidance counsellor, their assumption was that Melinda was acting out for attention.

Suicide is the number one cause of death in teens.

She was an unassuming, polite girl, but looked sad. She seemed adrift. Her school performance was good. She had friends and participated in school activities. I could not shake my impression that she was resigned to some predetermined fate.

Both her parents worked long hours. She had an eight-year-old brother. After school their nanny cared for them until her parents returned home. She said her parents had little time to spend with them. She missed that time and was concerned about how this affected her little brother. She did not want him to suffer the same rejection she felt from her parents. This was her reason for the pill overdose. She said if she killed herself her parents would spend more time with her brother. By removing herself from the family there would be only one child to focus upon. Perhaps then they would make time for him, she thought.

She did not want to tell her parents her reasons for taking pills. She did not want them to feel guilty. She loved them and felt they were working hard to help the family.

It was imperative she let her parents know how she felt. I suggested she write a letter to them if she was uncomfortable talking about it. The guidance counsellor and I both offered our support to help her communicate with her parents. She wished to do neither. I saw her only the one time. She did not return to me for followup.

But her guidance counsellor was able to follow up with her. She said Melinda did not resolve the issue that led to her overdose. She continued to consider herself an obstacle to her brother’s happiness. There were no further suicide attempts that school year. This occurred three years ago. She was lost to followup thereafter.

Everyday we face problems that seem unsolvable. I am struck by the degree of pain and suffering endured by some children. Melinda was willing to sacrifice herself to better the life of her brother. It is a sacrifice she should never even have had the opportunity to consider.

An interesting dichotomy exists at this age. Entering early adolescence, Melinda was beginning to mature and consider the problem from a different perspective. Yet her thinking demonstrated a childlike simplicity. She saw the problem as one requiring an immediate solution—although it had existed for some time. Little consideration was given to the consequences of her actions. Her behaviour was based in the present.

Future considerations or long-term solutions were not acceptable because they were incongruous with her world view. She loved her family yet did not consider the effect her suicide would have upon them. She did not feel valued, ergo her death would be of little consequence. In her pursuit to make her brother happy, her death would result in the opposite.

I wish she had come back. I want to reach out and protect teens like this from their altruistic yet misguided solutions to their problems. The parent in me wanted to make her happy. She needed someone to help her develop a sense of self-worth and perspective, a time-consuming process she rejected.

Professional demands insidiously consume our time. The time we spend with our family can be compromised. Parents try to be there for their kids. Children are remarkably resilient and recover from the occasional disappointment.

But I now have this image in my head of a child so utterly abandoned that I will never allow my sons to experience such despair. Work be damned.