To actually throw this life away?

Suicide prevention among adolescents

Dr. Heidi Vonwald and

MSc Gerhard Froehlich

Suicide! But what is a suicide?
A “no” in response to a question about meaning.
(Viktor E. Frankl)

Unbearable meaninglessness and emptiness of life can give rise to life-denying thoughts in minds of young people going through hard times and make them plan suicide to radically put an end to all their worries and eventually find serenity and safety. Among social and sociocultural factors, a family pattern has a strong triggering power, since the idea of suicide is often passed on from one generation to another as a “problem solution”. From the viewpoint of logotherapy and existential analysis, finding a way out of despair requires awareness of our unique mission in this world, recognition of our inherent GIFT-edness and CALL-ing and bringing them in a self-transcendent way into our world. It also needs a paradigm change – to see a challenge, a commitment in every stroke of fate that could provoke suicide, to search for a deeper meaning of the situation, to take responsibility for one's own life, to regain reasons to live, to feel again the “why” for one's existence. Because

A streaming life never runs dry. (Elisabeth Lukas)

Frankl illustrated with his vivid metaphors that the ebb (a crisis situation), though exposes a reef, is not a cause for the reef itself. Crisis situations can be interpreted as “salutary lessons” urging us to increasingly develop our potential.

Sick and tired of life? Crises are often brought about by typical life situations.
The overall development of a person from the very beginning flows unevenly, at a different pace. A young person can experience long-term changes at a new development stage; these challenges are of importance during the whole development history of a person, since the next development stage can be achieved only through these often complex and critical phases. As a rule, these difficult periods are not yet crisis situations, however, while progressing, they can sharpen and turn into psychosocial crises. Probably, the most important development stage of a person is puberty; in view of this fact, it is worthwhile to take a closer look at puberty and adolescence crises.

At this time, the central topic is dealing with pubescence, sexuality and opposite sex. The disillusionment (dis-illusion-ment – unveiling of truth?) and grievances related to it as well as increased self-doubts and mood swings may follow quickly. For other people, it may appear to be a mere “moodiness”. Laymen are not at all conscious of the underlying causes. Also, “more of the same” is often done, which is typical of the situation when “a solution becomes a problem” (Paul Watzlawick).

The young person is in search for suitable values and ideologies, but he or she cannot avoid existing ideologies. Meeting them, this person experiences the entire range of manifestations between complete merging in the system and breaking out. The question of meaning in life is urgently posed, at the latest, during this phase of ambivalence.
As Frankl already demonstrated, when a person is explicitly asked about the meaning of his existence, it means that he doubted it once. And these doubts about meaningfulness of human existence easily lead to despair and develop into an idea of suicide. Close reference persons too often react with helplessness, misunderstand the symptoms.

The more you try to be persuasive,
the more implausible you are.
(Humberto Maturana)

Even if, during this development stage, it comes to dramatic escalations, most young people cope with them without significant risks for further development.

Factors exerting a long-term influence during adolescence and under certain circumstances capable of provoking crises (according to Gernot Sonneck):

• emotional bonds in the family, the amount of trust, safety and security. Negative influence is exerted by authoritarian and repressive upbringing as well as neglectful and careless treatment of children and adolescents.

Paul Watzlawick adds on this point: “in a stable symmetric relationship, the partners are capable of accepting the other person as he is, which leads to mutual respect and confidence in being respected by the other partner and thus to realistic mutual acknowledgement of 'me' and 'you'-definitions”.

• Identification with the own sex role as well as dealing with genital sexuality, masculinity or femininity.

• Establishing contacts to similar males and females. Problems and conflicts linked to establishing and maintaining relations can provoke more serious crises (“lovesickness”).

• Successful or painful experience while searching for ideals and role models.

• Need for belonging to a group – for being a part of it – is very strong at this time, hence the risk of being drawn into a sect, a group of drug addicts etc.

• The encounter of adolescents with norms and values of the society.

The question of submission to the existing society norms is of great importance; living according to the performance principle means to be subjected to high pressures. Other value concepts are pushed into the background.

What does it mean specifically for a young person? It could be difficult for him to find meaningful life contents under current economic and social conditions. Facing the situation on the labour market (youth unemployment – mostly in the apprenticeship trade) with its enhanced performance requirements and existence pressure coupled with leisure opportunities serving mostly to commercial interests, young people have an increasing difficulty to find time and opportunity for their own unique development. The loss of traditions enhances crises connected with search for meaning and existential vacuum. But, nevertheless, we know that people with high resilience (lat. from resilire - “to leap back”) can develop healthily even in the severest circumstances. Individual experience of a young person is an essential factor in crises emergence: how he dealt with former crises, what he could have learnt coping with crisis situations and in what way he can apply the gained knowledge in the current crisis.

Martin Heidegger's follower, Hans-Georg Gadamer, has already stressed specific importance of “being internally reconciled with oneself”: “Internal attitude of a person and his community skills are basically the same thing. Only the person being friends with himself is able to adapt to community... Being friends with oneself. It has nothing to do with self-love or selfishness as it means the contrary of those. A person who is not friends with himself but cares only for himself is not capable of any dedication to others or any solidarity. This appears to me to be the root cause of self-alienation the spreading of which we observe in the life of modern civilization, and vice versa, it is an inalienable chance of us all to pursue our own occupation with consciousness of our own meaning in the midst of the unvarnished forced forms of our modern society.”

Clinical diagnoses are often relativized – spontaneous healing and change of symptoms occur rather frequently. “It is as you tell it.” (Heinz von Foerster). As professional helpers, we want neither to stigmatize nor to provoke iatrogenic neuroses.

Statement of a 17-year-old suicidal patient: “I am a borderliner, that is why I made so many suicide attempts.” It means: I assume no responsibility, I am a victim of my illness/diagnosis/childhood.

In logotherapy and existential analysis, we see the existential outcome.
 

“Not what life has given me -
but who I HAVE BECOME”.
(Elisabeth Lukas)

“What matters is not what our childhood made of us,
but what we do with what it made of us.”
(Jean Paul Sartre)

But we do not forget that suppressed traumatizations can be passed on through many generations. The example of 15-year-old Ali: a presenting symptom and a trigger of a suicide attempt – he jumped out of the 4th floor of the family-run hotel after his father had tried to force him against his will to take part in a one-week school event. Ali was an outsider in his class community, neither was he as a perpetrator of violence a teachers' favourite. He felt safe only in the vicinity of his mother. He suffered very much from the emotional inaccessibility of his mother, she was constantly overwhelmed, exhausted and depressive. As Ali's nightmares showed, he was extensively occupied with the traumatic past of his family. His mother together with his grandmother fled during Yugoslav war, and both suffered from Posttraumatic Stress Disorder (PTSD) which at that time had not been treated “because other people had felt much worse in the war”. They did not want to be regarded insane as they already suffered from unaccountable fear symptoms and unexpected aggression outbreaks. The mother's information about PTSD symptoms made it possible to open to a psychotherapeutic treatment by colleagues-logotherapists.

Indications of psychosocial crises of young people

Psychosocial crises of young persons are similar to those of adults, however, there are certain peculiarities (according to Gernot Sonneck):

• in almost all crises, physical complaints such as sleep disorders, gastro-intestinal disorders, headaches, flaccidity, tiredness appeared to be the only manifestation of the occurring crisis.

• behavioural disorders are often observable: changes in eating behaviour (lack of appetite in connection with weight loss or vice versa, immoderate eating often in the form of attacks), concentration difficulties, performance fluctuations or complete failure at school or work, avoiding old friends, family and interests, isolation, escape into an imaginary world, alcohol, drugs, medicine abuse etc.

• regression to a childish behaviour, e.g. sucking fingers, biting nails.

The crises which have not been mastered appear in diverse disease patterns (e.g. depression), panic or aggressive actions, e.g. running away from home, vandalism as well as suicidal actions.

Carina, a 17-year -old, has survived after a suicide attempt only by chance. She lay down with her veins cut open on the railway of an international train route. But she didn't know that the route was replaced by other transportation means as it was still closed because of the ongoing clean-up operations after the night storm. A dog found her late at night, and the dog owner called the ambulance. It is true: Chance is a place where wonder nests (Viktor E. Frankl). Due to her melancholy she has been unable to achieve anything in her life for a long time. Carina wasn't taken as an apprentice to a flower shop after probation, because in her absent-mindedness she was constantly forgetting things. And then it seemed to her that a possible “escape” through irreversible suicide which she had been thinking over for a long time could become her liberation and bring her the desired peace.

Frankl points to the trinity of failure:

• inability to work

• inability to enjoy

• inability to suffer.

Self-reproaches and accusations enhance these insufficiencies.

Treatment of young people in crises

In 1930, Viktor E. Frankl organized a counselling campaign for students up to the school leaving age – and for the first time there was not a single suicide among students in Vienna.

As we know from different studies, success or failure of a psychotherapy depends entirely on the relationship quality.
In the specialized literature it is repeatedly warned against assuming a role of a “buddy” as a professional helper.

Irvin Yalom takes up the right viewpoint:

“I like to consider my patients and me as persons travelling together. A perception that sets aside the distinction between “up” and “down” in the hierarchy.”

The first and vital prerequisite for a successful future working relationship in psychotherapy is the first contact. Patience and an appreciative attitude are essential. Pretended indifference, arrogance and even hostility are frequent behaviour patterns for adolescents to conceal their own needs. Authentic efforts to understand young people in their uniqueness is the only correct answer – only in such a way they can be motivated to cooperate, and the required trust can be established as a basis for a sustainable long-term transformation process.

Mentioning the limited time of the crisis intervention is insofar helpful as thus the young person can retain the feeling of control and autonomy, because he does not have to get involved into a prolonged process if he does not wish to. Even a one-time contact can set the desirable direction or show a possibility to ask for help later on.

It has proven to be favourable to schedule enough time for the initial session. A good approach can be insured mostly through everyday subjects or individual preferences of the young person. However, the interest must be authentic, otherwise it has a repulsive effect.

Sebastian, 17 years old, was already in the wheelchair, when I got to know him. From his point of view at that time, he unfortunately survived after a jump with his snowboard into an abyss. His mother brought him. Already at the street where I met him, he told me that he would not speak a word to me. I found this paradox amusing. When I asked him if he prefers my practice or the nearby café, he chose the café. I thought: a further success. The thing Sebastian did not know was that the nearby café was a  café for the handicapped.  Waiters in wheelchairs. In the café, his gaze rested at once on a newspaper about tractors. Through this topic we came into contact. He was a passionate expert who broadened my knowledge.  

A similar situation was with Janine, 16, she also declared not to speak to me. I have two cats. Janine's fondness for animals opened the door between us.

Brain research confirms that neuroplastic protein which is necessary for neuronal restructuring and learning results can be built in the nucleus only if we feel enthusiastic. Long-term changes in life need genuine enthusiasm, ability to forget oneself, complete devotion – as Frankl discovered a long time ago.

Nicole, 17, her difficulties at school have triggered a suicide attempt. The psychotherapy showed: she had a longing desire to get to know her father. She succeeded in it quickly through Facebook. He was of Egyptian origin. Her desire to learn Arabic to better get to know her “new” relatives in Africa was a strong stimulus to her.

What is to give light must endure the burning.

Adolescents have as a rule sensitive antennas for authenticity and continuity of the offered relationship and readily test reference persons in this respect. Discretion and secrecy have even greater significance than in the case with adults. Adolescents should be confident that the matter discussed will not be disclosed to a third party. When it is not possible because of the framework conditions, it should be clearly stated what information has to be disclosed and in which form it will take place.

It can be often difficult to estimate the potential danger because adolescents generally tend to mood swings, oversized ideas, occasional loss of reference to reality and seeing everything in black or in white (Berger, 1999). That is why indirect indications such as symbolic (drawings) or written expressions should be particularly taken into account when estimating the risk. In no case may it be overlooked that adolescents tend to exaggerate or conceal situations and conflicts.

Especially in the case of risk of suicide among adolescents, it is appropriate to give a view of the scenes and perspectives of death, as suicide never solves a problem, it is by no means – as Frankl stressed – an answer to any question.

“We must clearly show him how much he resembles a chess player who faces an over-challenging chess problem and throws the pieces from the board.”

In this case the misfortune always grows and the problem can be possibly expanded on further generations.

“And the same way as that chess player not keeping to the game rules, the person who commits suicide violates the rules of life.  These game rules do not demand from us to win at all costs, they demand to never give up fighting.”
(Viktor E. Frankl)

 

Frankl's appeal:
“Besides, who knows, may be several hours after the suicide the problem would have been solved?”

He also rejects suicide as a “consciously brought sacrifice”.

To prevent suicides, Viktor E. Frankl names in particular the following attitudes:

• with regard to spiritual dimension – suicide prophylaxis – to get rid of the respective spiritual cause of unhappiness and thus to eliminate the motive for suicide

• with regard to mental dimension – attitude modulation – to be not only capable of living without the missing thing but also to grow beyond this.

Orbach (1990) represents the view that it is reasonable to enhance the fear of death during a straight talk. The suicidal thoughts are though accepted and not condemned but the reality and irreversibility of death should be made clear to the young person, because those fearless of death but scared of life (Frankl) are never conscious of the fact that they will be actually dead then – since they search merely for ease and safety, and wish that “this at last comes to an end”.

It is considered to be proven that suicides are committed very rarely if a straight therapeutic relationship is established. The possibility to unburden one's heart and the experience of the genuinely caring and worrying psychotherapists mostly make suicides abate considerably. “To grow and to be a part of something are basic motivations of life” (Gerald Huether).

The  treatment of the current conflict has the highest priority. Taking small observable steps towards solving the problem and acquiring self-confidence gives hope for the next future. In this respect, assuming responsibility for the own deeds and actions is encouraged.

Also, the impact of the suicide on those alive should be made clear to the suicidal person – e.g. the burden especially for close relatives and friends – but also the negative role model for other people in suicidal crises!

“Suicide is though fearless of death but scaring of life.”
(Viktor E. Frankl)

Mere facts can be eliminated if they are unsuitable, but the predestined task can be either fulfilled or not fulfilled, and both remain in the world – own achievement as well as own failure. It is in fact similar to a self-murderer who neither ever solves the problem nor eliminates the negative situation which burdens him, but always eliminates only himself from the world and leaves the unsolved – unsolved by him - problem and the negative burden in the world... It had to be accomplished but has never been.” (Lukas 1989, S 145 f)

Depressive reactions

“Suicidal fantasies are the last hope when all other means could not relieve the burden of loneliness.”
(Erich Fromm)

New cases of depression among young people between 15 and 25 (especially in the cities) bring us Frankl's ideas much closer: loss of inner supportive forces such as traditional values, cultural traditions, spiritual ideas – where material values gain too much significance and loneliness in a crowd evolves. The easier consumability through the media results in an increasing physical inactivity. The excess of pictures in the media does not encourage to own actions, it can hardly inspire for an activity. The perceptional life is sensational, it rushes from one highlight to the other, but the real life becomes poorer, monotonous, boring, meaningless. The seizing paralysing melancholy drags desires, feelings and thoughts into the depth. Suicidal intentions come out of the inner self. At first, they just scare, but afterwards these thoughts can seem to be the last and only way-out for depressive people of any age.

Permanent failures at school, the atmosphere of parents' divorce, the lack of chance to relieve one's heart do the rest in triggering suicidal actions. The concept of the presuicidal syndrome according to Erwin Ringel is true for young people as well as for adults (constriction: situational, dynamic, narrowing of the world of values and interpersonal relationships; restrained aggression directed towards oneself, suicidal fantasies).

In the case of adolescents, however, the situational constriction occurs much more rapidly than in the case of adults. This constriction at a young age has also to do with action or symbolic language which is more associated with emotional rather than intellectual side. Suicidal actions are often a form of appeal to a “significant person”. In order to prevent suicides, it is necessary to overcome indifference towards things that drive other people. A planned suicide is mostly ambivalent – with a implication for the “significant person”. These implications are essential for suicide prevention. A sentence “nobody understands me” in connection with “I will show them” and the “Tom-Sawyer-Syndrom”, “when I no longer exist, they will see whom they have lost” - are an expression of the emotional state of presuicidal (young) people. Folk wisdom is mistaken in the belief: “People speaking of suicide never commit it”.

Raphael, 15, was a passionate football player – in front of a TV. When his parents broke up and his progress in gymnasium stopped (he hat to repeat a school year), hanging in his father's new flat (he left the family) was a clear sign – attack.

Cain asked: “Am I my brother's keeper?” - in psychotherapy this question is to be answered in the affirmative. Erwin Ringel illustrates this the best way with an example: As a young assistant entered the office of an overstrained secretary, he met a young doctor who was dictating a clinical history. She looked at Ringel and asked him to leave because she could not stand the colour of his tie. Two weeks later, his colleague committed suicide. Many years later, Ringel called attention to the fact that the suicidal experience a “colour shock” shortly before their violent end.

Dominik, 15, could not stand colours of his class-room any more (orange) before he plunged down the mountain peak during a hiking trip of his school class. Seriously injured, he could be saved. At first, he attracted his teacher's attention because of his scratches. Active contacts with his parents were not very productive. Until this suicide attempt.

With repeated obstinacy young people give vivid signals up to deliberately injuring themselves, self-mutilation and suicide attempts.

The most alarming indication of danger appears when it comes to aggression reversion, and after a lull period before storm an explosion-like answer to the alleged lack of understanding by reference persons and environment may follow.

And mostly at that time a suicidal action is taken, which should be prevented no matter whether it is para- or suicidal. As already mentioned, active listening can often be helpful, as the desperate young person is not “all on his own alone”. Suicidal crises in puberty are often triggered by unconscious conflicts.

Theresa, 17, wanted to commit a dual suicide together with her boyfriend Kevin, 17, both survived. Fortunately, joint suicides are rare phenomena, out of 1000 suicides only about 14 are dual ones. Some of them go down in history: Crown Prince Rudolf and Mary Vetsera. But also Stefan Zweig with his second young wife Lotte in Brazilian exile – Stefan Zweig has already been occupied with suicide previously in his works, many of his main characters considered it to be a problem solution.

Theresa, who had a symbolic relationship to Kevin, agreed to a joint suicide, as she had not been accepted by Kevin's parents as a “right” girlfriend (from a too poor family). The joint death should have saved her from destruction by Kevin's parents' house – and both could “prove” endless love by joint death.

Psychotherapy of depression with suicidality in childhood and puberty

“The one who takes notice of a crisis – differentiates.
The one who differentiates – gains the prerequisite to decide.
The one who decides, solves crises by taking a stance.”
(Dieter Lotz)

Whether consciously or not, everyone asks for meaning. Imparting of values starts in the experience sphere.

Warning signs of suicide risk for children and adolescents

(according to Kerns 1997)

• change of behaviour (a sociable child withdraws into himself)

• negligence of one's own appearance

• social withdrawal, isolation

• giving away one's personal valuable belongings

• increased attention to the issue of death

• open or hidden suicidal intentions

• previous suicide attempts

• contemplation on suicide methods

• excessive consumption of alcohol or drugs

• lagging behind at school

• sudden high spirits

• frequent accidents

• running away, escaping

There are fundamental differences in the psychotherapeutic work with children under and over 12:

Children under 12:

To the front comes cognitive immatureness and impulsiveness. Suicidal thoughts are accompanied by feelings of despair and guilt, the children show a picture of aggressiveness and irritability. At that, family and school conflicts are the main risk factor, e.g. problems with discipline and mobbing at school or confrontations within the peer group.
In case of suicidal tendency, hospitalization is always advisable when the child must be taken out of the conflict situation.

Suicides are very rare in Austria among children under 14, (0,3/100.000) – similar data are obtained in Switzerland. In the case of adolescents and young adults (aged 15 to 24), overall suicidal tendency is 13,0/100.000. Girls attempt to commit suicide three times as often as boys. On the other hand, suicide attempts among boys lead three times as often to death as those among girls. Male adolescents resort to “hard” means as, e.g. death by handing, shooting or throwing themselves in front of the train. They want to “carry suicide through”, mere attempts are rare. On the contrary, suicide attempts among girls and women are often of a vividly appealing nature and do not aim inevitably at death (para-suicide).

“Actually I'm quite different. But I so rarely have time to show it."
(Ödön von Horvath)

16-year-old Josephina cut her wrists open but timely phoned her parents. She had many physical complaints, fears and a strong need for control. She had “everything” but still could not be happy. Massive feelings of guilt seized her because “others had less”. She felt the best in the nearby farm, but her parents were reluctant to this, as “she stank of stable” - and she'd rather practice her fourth foreign language, Russian was important for the expansion to the East – this knew her successful father – till Josephina's suicide attempt. He understood his daughter's appeal and was deeply shocked. As the nearby farm sheltered Ukrainian refugees, Josephina's Russian language skills improved significantly – she insisted on the young family's talking to her only in Russian and replied in German. Spontaneous healing – by no means a surprise! Keen interest, enthusiasm, elevated mood at work produce such side-effects as joy and first of all quick wits, flexibility and creativity. We reach our maximum efficiency much easier, we take our tasks as challenges, we live up to them. A bit of pressure (stage fright) enhances concentration and motivation.

In emotionally loaded situations, people have three reaction possibilities: attack, escape and stupor. The suicide trigger is clearly distinguished from the reason to take this decision. Failure at school, work or in a love relationship are triggers for turning the suicidal fantasies into reality, whereas the cause lies deeper, is linked to the life story of the young person and reveals e.g. his dependence, his pyramidal values arrangement (a core values becomes a sore value), his feelings of inferiority.

Neither shall cultural discrepancies be overlooked. Also, those between North America and Europe. Time and again American and Canadian young women raped by young men during their stay in Europe as exchange students have been coming to my practice for many years. Luckily, there is a study published by Paul Watzlawick which affirms that mating behaviour in North America and Europe differs and is therefore misunderstood. In both cultures, there are about 30 stages up to an intimate, metaphysical relationship. But: kisses come in North America at stage 5 and in Europe at stage 25!

Anne, 17, exchange student from Los Angeles, after passionate kissing followed her neighbour, 23, into his flat. The attractive ski instructor found her wild resistance “classy” - he did not understand her clear signs. Anne perceived it as sexual abuse. He was her first man. Inwardly, she has not been ready for this last step yet.

Re-integration into life – logotherapeutic approach

“Only that one can let go what he HAS,
who is at home in what he IS.”
(Elisabeth Lukas)

It is deeply rooted in us – even unconsciously – that we want to accomplish something in the world, leave positive marks, something permanent and meaningful using our genetically inherent potential.

By his (mostly daring) decisions, actual deeds and much endurance, every single person can change the world history, even if in the small!  Young people often yearn to strike an extraordinary path which would express the peculiarity in their personality. Young people must fulfil themselves through their positive deeds in this world. Living meaningfully, doing  meaningful things belong to the most fundamental motives of a person.

In his inaugural address of 1994, Nelson Mandela reminds us that our deepest fear is not our darkness, it is our light, that most frightens us. We just need the light power of the spiritual insight to help us get away from the dark heaviness that paves the way for suicide.

Franca, 16, was a “failed existence” (as she called herself after a suicide attempt followed by a stay in a psychiatric hospital). After persistent efforts, her parents managed to find her a “clean” job in an office. Every day she went to work seized with fear, - the fact that this firm was well-known could not comfort her. Her parents' statement “Working life is hard” strengthened her unwillingness to live this way any more. After psychotherapy she changed her profession. “House painter and finisher” - very unfeminine for this young attractive woman. She was taken on at once after her probation period. Now she enjoys her long daily way to work (a distance of nearly 60 minutes) by train. On the way she improves her Italian, as she contacts with many Italian-speaking customers. - When we are inflamed by inspiration, no way is too long.

The findings in natural science prove that the following factors exert a particularly negative influence on our work performance:

Growing fear reduces our abilities.

The stronger the pressure, the poorer are our performance and mental capacities, the more we are hampered in our flexible and creative reaction, we cannot plan or organize things effectively any more.

If we are seized with fear, distress or resentment, our mental mobility stalls.

Extreme conditions of anger, fury as well as sorrow reduce the capabilities of our brain.

Boredom and meaninglessness also decrease our motivation.

Bad-tempered teachers transmit negative mood; additionally, they concentrate more on mistakes. Emotional distress stifles our performance.

Roland, 15 at that time, was a social orphan placed out of home and lagged behind at school. His drug-addicted parents could not take care of him. More than 20 years ago, after a failed suicide attempt he came for a psychotherapy. He was a “dog whisperer” - the work in a pet shelter cured him. He needed not more than a year to restore his interest in studies to get his high school diploma. In the meantime, Roland is a veterinarian, married, has three children with his wife, they all take care of two dogs, a cat, a horse and three guinea pigs.

To win back primordial trust..
..by strengthening the authentic “self” (“be who you are!”) is essential in every psychotherapy, whether for young people or those over 17.

..Primordial trust is based on the assumption that the essentially good and essentially meaningful is realized in a broader perspective, it is taken and retained in the “genuinely good” (Elisabeth Lukas, in “Restoring Primordial Trust” (“Urvertrauen gewinnen”), p. 51f).

Personal responsibility

To stress one's own free space, to be the master of one's own life, the respective situation can be managed and improved with one's own efforts, to cultivate attitudinal values and contacts in case of fateful circumstances, but also to learn to be alone (all-one – at one with everything).

Self-transcendence

To give proactive (instead of reactive) answers to the questions that urge into life: does anything fascinating attract me? Something essential, that should be answered by me right away? What questions urge into my life?

Motivate to live, to answer the “what for” question

Courage is the opposite to despondency. With courage in their hearts, young people can devote themselves to life. Courage makes us able to encounter the world again. The following questions can also be helpful: What is my deepest fear? What is that, what I have always wanted to do, what has always been important to me?

Posing the questions, always try to obtain a very exact description for the patients to get an inner image, to be able to recall it quicker – provide an entire perception training – to pay more attention to the healing and the grateful in life: What life task would mean much to me? What is high time for me to do?

I did not know it was impossible, so I did it.
(Jean Cocteau)

The conscious dealing with death – not only for our clients – our attitude to suicide is essential. Rejection of life, possible suicide and setting high goals in life become very apparent in the case of young people. Imitation in the infancy period as well as later acknowledgement of the authority go by, the young person wants to bring something meaningful into life using his power of judgement. The young person should open himself to the world with all those possibilities that are offered to him in their abundance. Through key experience, primordial trust can be then strengthened. The ability of a sensible encounter is our goal in psychotherapy, including suicide prevention. Young people do not directly ask what meaningful things they can bring into our world. In their case it is still more projective:

How do I feel our Earth?

What education could do?

What people do I want to live with?

Positive, good power can be sensed this way – to discover it in anxious young people is the goal of psychotherapy.

Uwe Böschemeyer stresses that success does not have to follow automatically, it can sometimes be arduous. The inner polarity between acceptance and denial of life, the fear to fail can prevent us from taking important decisions, from daring something new; lingering in the old and familiar gives the sense of security.

Everything changes. You can make
A fresh start with your final breath.
But what has happened has happened. And the water
You once poured into the wine cannot be
Drained off again...
Everything changes. You can make
A fresh start with your final breath.
(Bertold Brecht, 1898 – 1956, German playwright, poet)

Mother of Claire, 15, got married again and, apart from stepfather, also brought a 15-year-old girl into the “previously happy” (according to the client's words) family. Jealousy and deep anger motivated Claire to cut her wrists in her stepfather's firm. She was found by  cleaning staff and timely brought to a clinic. Anger and fury are often mixed with sorrow and despair. Before she started her psychotherapeutical treatment, Claire focused predominantly on accusations, attacking and criticizing.

A person lingering in anger, rage, hatred, fury tends to generalizations: Everybody in the family is mean, always... -
Exceptions, cases of successful relationships in the family are not any more or hardly perceived.

A self-fulfilling prophecy comes true: if one gets stuck in fury and rage, his feeling of helplessness grows.

Young people also long for wholeness and safety in something which is beyond them. When people feel not wanted, loved or supported in life, not only emotional but also existential stress arises – and then they do not live any more – a thing which is specifically human – then they live against their own self.

Fury and anger towards ourselves

“Inability to settle one's own affairs”.
Existential stress: vacuum and meaninglessness
A way out: To go on search for meaning – what can I accomplish in this world?

Fury and anger towards others

“to feel dependent on others”
Existential stress: feeling of helplessness

To go back to one's own free space, to see the possibilities which are open, to make the last preliminary effort (I am doing the first step – unintentionally – because I stay in contact with my inner eminence, I do not get too much dependent on others – good things remain good – and leave their mark on the earth.)

The person must stop hyper-reflexion - “I do not have to tolerate everything from myself” (Viktor E. Frankl).

Who flies my plane? (a metaphor of Elisabeth Lukas)

Body – plane body, soul – feelings, spirit – pilot.
I must not allow my feelings to fly my plane – I am a pilot.

Who rides my horse? Does my fury hold the reins? Do I feel like a victim?
It should not be this way! - We are masters of our feelings. A way out: to stop one's thoughts  - to be in here and now – to be able to perceive the meaning of the moment (what is meaningful now, necessary to do?) To ask one's conscience!

“What disturbs men’s minds is not events but their judgements on events.
So, when we face difficulties,
get restless or distressed,
we should not put the blame on somebody else,
but only on ourselves,
that is,
on our judgement of events.”
Epiktet (ancient philosopher, approx. 50/60 – 130)

Every minute decides what our life IS; thus, it is decided what once will have been! Time does not flow us by, on the contrary, we are managers – not victims – of our time! “To finish” is not our primary goal – our goal is rather to introduce, bring about, set something in motion, leave positive traces,..

What life issues occupy me the most at this moment? Do they strike the right chord in me? Am I still living or a little bit dead – caught in the repetition compulsion?

How can I act in harmony with reality again?

Paradise is not a place, but a mental attitude.
(N. Peseschkian, 1933 – 2010, Founder of Positive Psychotherapy)

One case, many cases?

A final impulse for professional helpers to reflect on:

One case, many cases.
From case to case we discuss
each case variously long.
The abandoned seek those helping up,
not to be defeated.
The fallen down stretch out towards
those lifting up
not to fall behind.
From case to case we also fall
into dark holes of helplessness when lacking ideas.
If we fall:
who and how speaks about us
as a case
and
who lifts us
in the case of a fall¹?
[Dieter Lotz]

1 In German, a pun using words with stem „fall“: Fall – 1) case, 2) fall, fallen – to fall, Fallengelassener - abandoned, Hingefallener – fallen down, einfallslos – lacking ideas, falls – if, in case.