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'Sad is how I am!' Treating Dysthymia in Children and Adults

Section 24
Adolescent’s “Sadness” and Suicide
Reproducible Client Information Sheet

Question 24 | Test | Table of Contents

Up until twenty years ago, the medical profession as a whole did not believe that children and teenagers got depressed. They were convinced that childhood and adolescence were carefree times, times free of major problems. Only older people, they reasoned, could be depressed. How wrong they were! Study after study now confirms that depression is common in young people. As many as one in every five teenagers may be depressed. According to the National Association for Mental Health, nearly 20 percent of those who receive care for depression in hospitals and clinics are under the age of eighteen. And, while many young suicides did not seem depressed, depression now appears to be the single most common cause of teen suicide.

“Stop Me, Please”

1. Seventy-five percent of suicide attempters give repeated warnings. They tell their friends, sometimes even their families, that they want to die. They are asking for help.

2. Nine out of ten teenagers who attempt suicide do so in the home, where there is a good chance that someone will stop them.

3. In the few months before taking their own lives, seventy-five percent of the victims had seen their family doctor. Many of them were also seeing a psychiatrist.

Changes in Dysthymic Adolescent Motivation
The motivational changes in depressed adolescents may be considered under four groupings: paralysis of the will, escapist and avoidance wishes, suicidal wishes, and intensified dependency wishes. The sequential relationship between cognition and motivation may be observed under two conditions. First, by knowing an individual’s cognitions one can predict his or her motivation or lack of motivation. Second, by changing the cognition one can change the motivation.

The loss of spontaneous motivation, or paralysis of the will, has been considered a symptom par excellence of depression in the classical literature. The loss of motivation may be viewed as the result of the patient’s hopelessness and pessimism; as long as he expects a negative outcome from any course of action, he or she is stripped of any internal stimulation to do anything. Conversely, when he or she is persuaded that a positive outcome may result from a particular endeavor, he or she may then experience an internal stimulus to pursue it.

Avoidance and escapist wishes are similarly related to expectations of a negative outcome. A moderately depressed student had a strong desire to avoid studying. He felt that he would find the material dull and boring. I pointed out to him that he had always enjoyed studying this particular material once he became absorbed in it. When he could see the possibility of some gratification, he experienced a desire to study. With the change in his expectancy came a consequent change in his motivation.

The suicidal wishes may be regarded as an extreme expression of the desire to escape. The suicidal patient sees his future as filled with suffering. He cannot visualize any way of improving things. He does not believe it is possible to get better. Suicide under these conditions seems to the patient to be a rational solution. It promises an end to his own suffering and a relief of the supposed burden on his family. Once suicide appears as a reasonable alternative to living, the patient feels attracted to it. The more hopeless and painful his life seems, the stronger his desire to escape from that life.

The wish to escape from life via suicide because of suffering and hopelessness is illustrated in the following quotation from a patient who had been rejected by her boyfriend. "There’s no sense in living. There’s nothing here for me. I need love, and I don’t have it anymore. I can’t be happy without love -- only miserable. It will just be the same misery, day in and day out. It’s senseless to go on.”

The desire to escape from the apparent futility of his existence was expressed by another patient. "Life is just to go through another day. It doesn’t make any sense. There’s nothing here that can give me any satisfaction. The future isn’t there. I just don’t want life anymore. I want to get out of here. It’s stupid just to go on living.”

Another false premise that underlies the suicidal wishes is the patient’s belief that everybody would be better off if he or her were dead. Since he or she sees himself or herself as worthless and as a burden, arguments that his or her family would be hurt if he or she died seem hollow. How can they suffer from losing a burden? One patient envisioned killing herself as doing her parents a favor. She would not only end her own suffering but would relieve them of psychological and financial responsibilities. “I’m just taking money from my parents. They could use it to better advantage. They wouldn’t have to support me. My father wouldn’t have to work so hard and they could travel. I’m unhappy taking their money and they could be happy with it.”

In a number of cases, the suicidal wishes were ameliorated by examining the underlying premises and considering alternative solutions. A patient became depressed because he had lost his job. He said, “I want to shoot myself. Nobody thinks I’m capable of doing anything. I don’t think so either. I’ll never get another job. I don’t have any friends or dates. I’m isolated. I’m just completely stuck for all time. If I shot myself, it could solve all my problems.

The increased dependency that is so characteristic of many depressions may be attributed to a number of factors. The patient sees himself in negative terms -- as being inept, inadequate, and undesirable. Furthermore, he tends to overestimate the complexity and difficulty of the normal details of living. In addition, he expects everything to turn out badly. Under these conditions, many depressed patients yearn for somebody strong to take care of them and to help them with their problems. They often tend to magnify the strength of the person on whom they are dependent. One woman who generally disparaged her husband when she was not depressed regarded him as a kind of superman when she was depressed.

As with other motivations, dependency wishes may be attenuated if the patient can view himself and his problems more objectively. As his self-esteem improves and he sees ways of coping with his problems, he feels less driven to seek help from others. The relation between cognition and motivation has also been demonstrated in a controlled experimental situation. We found that patients who (as the result of the experimenter’s manipulation of the degree of difficulty of an assigned task) viewed their performance on a task as inferior were less motivated to volunteer for a new experiment than those who believed their performance was superior.

Adapted from Dead Serious: A Book for Teenagers About Teenage Suicide. Leder, Jane Mersky. Atheneum: NY, NY. 1987

“Personal Reflection” Journaling Activity #4
The preceding section contained information on adolescent sadness and suicide. Write three case study examples regarding how you might use the content of this section of the Manual in your practice.

Update
Sadness, Hopelessness and Suicide Attempts
in Bullying: Data from the 2018 Iowa Youth Survey

Newman, K. L., Alexander, D. S., & Rovers, J. P. (2023). Sadness, hopelessness and suicide attempts in bullying: Data from the 2018 Iowa youth survey. PloS one, 18(2), e0281106.

Peer-Reviewed Journal Article References:
Dutt, A. J., Wahl, H.-W., & Rupprecht, F. S. (2018). Mindful vs. mind full: Processing strategies moderate the association between subjective aging experiences and depressive symptoms. Psychology and Aging, 33(4), 630–642.

Greenberg, J., Datta, T., Shapero, B. G., Sevinc, G., Mischoulon, D., & Lazar, S. W. (2018). Compassionate hearts protect against wandering minds: Self-compassion moderates the effect of mind-wandering on depression. Spirituality in Clinical Practice, 5(3), 155–169.

Seli, P., Beaty, R. E., Marty-Dugas, J., & Smilek, D. (2019). Depression, anxiety, and stress and the distinction between intentional and unintentional mind wandering. Psychology of Consciousness: Theory, Research, and Practice, 6(2), 163–170.

QUESTION 24
What are four motivational changes in depressed adolescents? To select and enter your answer go to Test.

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