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Will's Choice: A Suicidal Teen, a Desperate Mother and a Chronicle of Recovery
BOOK REVIEWS
titled BIf Your Child Asks FAre you going to die?_[ ever been written? In a career in pediatric psychiatry, I have not seen one; yet charged issues such as these come up often in clinical child and adolescent psychiatry practice in medical settings. Although the focus of the book is parent illness, the wisdom is more broadly applicable: Rauch and Muriel repeatedly emphasize several fundamental principles in dealing with children in the setting of medical illness: Individualizing the approach to children of an ill parent, avoiding a Bone size fits all[ approach such as Ball children of a dying parent should receive psychotherapy or none should,[ or Ball children older than age 4 should attend a deceased parent_s funeral or none should.[ By adapting sound clinical principles drawn from the most current, bestsupported transactional models of child and family development, the authors return often to the fundamental themes of asking children good questions, sizing up what is behind the questions children ask parents and caregivers; being sensitive to unspoken worries; asking for and respecting children_s stated preferences regarding hospital visits, funeral attendance, explanation of parent symptoms; functional limitations; and related topics. Specialized issues for which the best clinician_s intuition may fail, such as the child_s perspective on genetic screening when the parent has a serious, heritable illness, are included and addressed using the same developmental rigor as more Btraditional[ topics. Raising an Emotionally Healthy Child When a Parent Is Sick addresses a crucial and previously unmet set of needs guiding parents in facilitating the adaptation and healthy emotional development of children in a world in which chronic lifelimiting parent illness is increasingly prevalent. By normalizing the child_s experience and framing parent guidance in the most current wisdom child developmental theory and clinical practice have to offer, Paula Rauch and Anna Muriel have added a valuable volume to our literature. I recommend it to professionals and parents alikeVbe they ill or well. John P. Glazer, M.D. Department of Psychiatry and Psychology The Cleveland Clinic Foundation Cleveland DOI: 10.1097/01.chi.0000219825.85731.ec
Disclosure: The author has no financial relationships to disclose.
Will_s Choice: A Suicidal Teen, a Desperate Mother and a Chronicle of Recovery. By Gail Griffith. New York: HarperCollins Publishers, 2005, 320 pp., $24.95 (hardcover).
888
My first thought upon reading the title of Gail Griffith_s book was that the choice in question referred to the decision of whether to write a book as part of the recovery process of a family whose adolescent member had made a serious suicide attempt. I routinely recommend the works of Goethe (1962), Eugenides (1993), and Jamison (1999) to trainees wanting to better conceptualize adolescent suicide, a tragedy we do not prevent nearly as well as we would like. I rarely recommend the same books to family members of a suicidal youth. We try to help parents be informed, vigilant, and careful, while also hopeful. These books do not usually induce or foster hope. Thus, I opened Will_s Choice hoping to find a book that could help the families of adolescents who have just attempted suicide. I was also curious about the decision made to write the book: What had Will thought about it initially? Did he have reservations? Was he worried about his privacy? How did he and his mom work things out? In fact, around page 30, I realized that the choice in question refers to Will_s suicide attempt. According to the Oxford English Dictionary, the word refers both to Bthe act of choosing[ and to the Bthe power, right, or faculty of choosing.[ Whether the latter includes the capacity of those like Will who have seriously attempted or completed suicide does not have a straightforward answer: Mental illness can seriously distort or impair the capacity to choose. Acute changes in behaviors do not necessarily reflect free choices. When it comes to suicide, a behavior highly associated with psychiatric illnesses, we typically rely on the surviving suicide attempter to decipher whether the act was undertaken with diminished or limited capacity, and thus a lucid choice or not. Why belabor the point of free will and legitimacy of choice? Perhaps because in the book_s moving epilogue, in which we finally meet Will writing to us in the first person, we do not find the answer to this question. Instead, we meet a thoughtful, funny, and elusive young man who is feeling Bmuch better[ but B[doesn_t] know what to say,[ noting BI don_t know you[ (p. 297), and more important that Bwhen [he] was severely depressed, the pills didn_t try to kill him, [he] did[ (p. 299). However, we have learned about aspects of Will_s familial context after reading his mother_s book. Will_s suicide attempt has repeatedly been presented and formulated to us and to him along the way as a Bdisastrous[ choice. Will describes earlier both Bembarrassment[ about the suicide attempt and continued discomfort with the revulsive thought that he Bhurt a lot of people.[ Will does not like to talk or think about his suicide attempt much. It is hard to interpret the face value of his statement of responsibility. We also cannot guess whether the writing of the book bothered him or just how much. Although he implicitly supports his mom, this book is not really about his choice. It is about Will_s mother Gail and her choice to expose honestly, candidly, and as comprehensively as she can
J. AM . AC AD. C HILD ADOLESC. PSYCHIATRY, 45:7, JULY 2006
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
BOOK REVIEWS
what she went through following her son_s potentially fatal suicide attempt in March 2001. The first thought Gail Griffith remembers having on the morning she found her 17-year-old son in his bedroom, drooling, tachycardic, and delirious, is Bencephalitis. Not suicide. En-ceph-a-li-tis[ (p. 10). To trainees, I would highly recommend the reading of the chapters where she simply cannot let herself consider or believe that her son could have tried to kill himselfVnot until insurmountable evidence shakes her out of denial and throws her into other stages of grief. For parents and friends, the tragedy of losing a child to suicide is often intensified by the horrible feeling that they were blindsided. Gail Griffith describes this parental incredulity well. I would also recommend reading her firstperson account of forging past her grief to try to get knowledge, certainty, and a solution to the problem. She gets knowledge that she details extensively, but neither certainty nor a guaranteed permanent solution to the problem. What is not broadly described in her book are details of environmental factors that may have influenced Will. Griffith divulges that she too suffers from depression and that her disorder may have had a profound impact on her life and her children_s lives (for example, through her divorce from Will_s biological father). However, she underlines being told that Will_s depression was one of the most Bbiological[ ones ever, whatever that professional observation was intended to convey. It is easy to wonder whether the thought of genetic transmission (Bmost biological[) is less painful and easier to convey than dwelling on the role that the Benvironment[ may have played: How was Will taught to communicate his thoughts and feelings? How did Gail parent her children when she was depressed? Was Will worried about his mom and did he feel like he had to take care of her or at least avoid adding to her pain? Does this relate at all to Will_s discomfort to label painful and unpleasant thoughts? These questions are mostly unexamined.
So would I recommend this book to parents who have just experienced a child_s first suicide attempt? Yes, but with several caveats. First, most adolescents who have made a suicide attempt are treated in less restrictive settings than the residential treatment center in which Will spent many months. Second, Will_s family members felt betrayed by his Bchoice,[ a view that is not likely to be espoused by all. For example, he Bwent away[ explicitly for treatment, care, and rehabilitation, but implicitly because he could not be trusted after his dangerous unpredictable behavior. In the end, we should applaud Griffith for taking a painful topic head on and for writing a sometimes illuminating book. I just do not know how much of a choice Will had in the making of a book that showcases a behavior he may in the first place have had little choice in. As a child and adolescent psychiatrist, this left me wondering. Anne L. Glowinski, M.D., M.P.E. Washington University School of Medicine St. Louis DOI: 10.1097/01.chi.0000219825.85731.ec
Disclosure: The author has no financial relationships to disclose. Goethe JW (1962), The Sorrows of the Young Werther and Selected Writings. New York: Penguin Books Eugenides J (1993), The Virgin Suicides. New York: Warner Books Jamison KR (1999), Night Falls Fast: Understanding Suicide. New York: Vintage Books
Note to Publishers: Books for review should be sent to Andre´s Martin, M.D., M.P.H., Yale Child Study Center, 230 Frontage Road, P.O. Box 207900, New Haven, CT 06520-7900.
Running on Empty: Families, Time, and Workplace Injuries Leslie I. Boden, PhD Over the past 5 decades, more women have entered the labor force, and more households have been headed by single parents. Both trends have substantially reduced parents’ free time, creating added strain in the event of family health problems, including work-related injuries and illnesses. This commentary presents evidence about the impact of occupational injuries on today’s families. In addition to losing considerable income, injured parents are less able to do household work, and other family members are often called on to care for them. Family members cut back on their paid, school, and household work to fill in for the injured parent. This suggests the importance of policies to help today’s time-strapped families cope with major family health events. American Journal of Public Health 2005;95:1894 Y 1897.
J. AM. ACAD. CH ILD ADOLESC. PSYCH IATRY, 45:7, JULY 2006
889
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
titled BIf Your Child Asks FAre you going to die?_[ ever been written? In a career in pediatric psychiatry, I have not seen one; yet charged issues such as these come up often in clinical child and adolescent psychiatry practice in medical settings. Although the focus of the book is parent illness, the wisdom is more broadly applicable: Rauch and Muriel repeatedly emphasize several fundamental principles in dealing with children in the setting of medical illness: Individualizing the approach to children of an ill parent, avoiding a Bone size fits all[ approach such as Ball children of a dying parent should receive psychotherapy or none should,[ or Ball children older than age 4 should attend a deceased parent_s funeral or none should.[ By adapting sound clinical principles drawn from the most current, bestsupported transactional models of child and family development, the authors return often to the fundamental themes of asking children good questions, sizing up what is behind the questions children ask parents and caregivers; being sensitive to unspoken worries; asking for and respecting children_s stated preferences regarding hospital visits, funeral attendance, explanation of parent symptoms; functional limitations; and related topics. Specialized issues for which the best clinician_s intuition may fail, such as the child_s perspective on genetic screening when the parent has a serious, heritable illness, are included and addressed using the same developmental rigor as more Btraditional[ topics. Raising an Emotionally Healthy Child When a Parent Is Sick addresses a crucial and previously unmet set of needs guiding parents in facilitating the adaptation and healthy emotional development of children in a world in which chronic lifelimiting parent illness is increasingly prevalent. By normalizing the child_s experience and framing parent guidance in the most current wisdom child developmental theory and clinical practice have to offer, Paula Rauch and Anna Muriel have added a valuable volume to our literature. I recommend it to professionals and parents alikeVbe they ill or well. John P. Glazer, M.D. Department of Psychiatry and Psychology The Cleveland Clinic Foundation Cleveland DOI: 10.1097/01.chi.0000219825.85731.ec
Disclosure: The author has no financial relationships to disclose.
Will_s Choice: A Suicidal Teen, a Desperate Mother and a Chronicle of Recovery. By Gail Griffith. New York: HarperCollins Publishers, 2005, 320 pp., $24.95 (hardcover).
888
My first thought upon reading the title of Gail Griffith_s book was that the choice in question referred to the decision of whether to write a book as part of the recovery process of a family whose adolescent member had made a serious suicide attempt. I routinely recommend the works of Goethe (1962), Eugenides (1993), and Jamison (1999) to trainees wanting to better conceptualize adolescent suicide, a tragedy we do not prevent nearly as well as we would like. I rarely recommend the same books to family members of a suicidal youth. We try to help parents be informed, vigilant, and careful, while also hopeful. These books do not usually induce or foster hope. Thus, I opened Will_s Choice hoping to find a book that could help the families of adolescents who have just attempted suicide. I was also curious about the decision made to write the book: What had Will thought about it initially? Did he have reservations? Was he worried about his privacy? How did he and his mom work things out? In fact, around page 30, I realized that the choice in question refers to Will_s suicide attempt. According to the Oxford English Dictionary, the word refers both to Bthe act of choosing[ and to the Bthe power, right, or faculty of choosing.[ Whether the latter includes the capacity of those like Will who have seriously attempted or completed suicide does not have a straightforward answer: Mental illness can seriously distort or impair the capacity to choose. Acute changes in behaviors do not necessarily reflect free choices. When it comes to suicide, a behavior highly associated with psychiatric illnesses, we typically rely on the surviving suicide attempter to decipher whether the act was undertaken with diminished or limited capacity, and thus a lucid choice or not. Why belabor the point of free will and legitimacy of choice? Perhaps because in the book_s moving epilogue, in which we finally meet Will writing to us in the first person, we do not find the answer to this question. Instead, we meet a thoughtful, funny, and elusive young man who is feeling Bmuch better[ but B[doesn_t] know what to say,[ noting BI don_t know you[ (p. 297), and more important that Bwhen [he] was severely depressed, the pills didn_t try to kill him, [he] did[ (p. 299). However, we have learned about aspects of Will_s familial context after reading his mother_s book. Will_s suicide attempt has repeatedly been presented and formulated to us and to him along the way as a Bdisastrous[ choice. Will describes earlier both Bembarrassment[ about the suicide attempt and continued discomfort with the revulsive thought that he Bhurt a lot of people.[ Will does not like to talk or think about his suicide attempt much. It is hard to interpret the face value of his statement of responsibility. We also cannot guess whether the writing of the book bothered him or just how much. Although he implicitly supports his mom, this book is not really about his choice. It is about Will_s mother Gail and her choice to expose honestly, candidly, and as comprehensively as she can
J. AM . AC AD. C HILD ADOLESC. PSYCHIATRY, 45:7, JULY 2006
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.
BOOK REVIEWS
what she went through following her son_s potentially fatal suicide attempt in March 2001. The first thought Gail Griffith remembers having on the morning she found her 17-year-old son in his bedroom, drooling, tachycardic, and delirious, is Bencephalitis. Not suicide. En-ceph-a-li-tis[ (p. 10). To trainees, I would highly recommend the reading of the chapters where she simply cannot let herself consider or believe that her son could have tried to kill himselfVnot until insurmountable evidence shakes her out of denial and throws her into other stages of grief. For parents and friends, the tragedy of losing a child to suicide is often intensified by the horrible feeling that they were blindsided. Gail Griffith describes this parental incredulity well. I would also recommend reading her firstperson account of forging past her grief to try to get knowledge, certainty, and a solution to the problem. She gets knowledge that she details extensively, but neither certainty nor a guaranteed permanent solution to the problem. What is not broadly described in her book are details of environmental factors that may have influenced Will. Griffith divulges that she too suffers from depression and that her disorder may have had a profound impact on her life and her children_s lives (for example, through her divorce from Will_s biological father). However, she underlines being told that Will_s depression was one of the most Bbiological[ ones ever, whatever that professional observation was intended to convey. It is easy to wonder whether the thought of genetic transmission (Bmost biological[) is less painful and easier to convey than dwelling on the role that the Benvironment[ may have played: How was Will taught to communicate his thoughts and feelings? How did Gail parent her children when she was depressed? Was Will worried about his mom and did he feel like he had to take care of her or at least avoid adding to her pain? Does this relate at all to Will_s discomfort to label painful and unpleasant thoughts? These questions are mostly unexamined.
So would I recommend this book to parents who have just experienced a child_s first suicide attempt? Yes, but with several caveats. First, most adolescents who have made a suicide attempt are treated in less restrictive settings than the residential treatment center in which Will spent many months. Second, Will_s family members felt betrayed by his Bchoice,[ a view that is not likely to be espoused by all. For example, he Bwent away[ explicitly for treatment, care, and rehabilitation, but implicitly because he could not be trusted after his dangerous unpredictable behavior. In the end, we should applaud Griffith for taking a painful topic head on and for writing a sometimes illuminating book. I just do not know how much of a choice Will had in the making of a book that showcases a behavior he may in the first place have had little choice in. As a child and adolescent psychiatrist, this left me wondering. Anne L. Glowinski, M.D., M.P.E. Washington University School of Medicine St. Louis DOI: 10.1097/01.chi.0000219825.85731.ec
Disclosure: The author has no financial relationships to disclose. Goethe JW (1962), The Sorrows of the Young Werther and Selected Writings. New York: Penguin Books Eugenides J (1993), The Virgin Suicides. New York: Warner Books Jamison KR (1999), Night Falls Fast: Understanding Suicide. New York: Vintage Books
Note to Publishers: Books for review should be sent to Andre´s Martin, M.D., M.P.H., Yale Child Study Center, 230 Frontage Road, P.O. Box 207900, New Haven, CT 06520-7900.
Running on Empty: Families, Time, and Workplace Injuries Leslie I. Boden, PhD Over the past 5 decades, more women have entered the labor force, and more households have been headed by single parents. Both trends have substantially reduced parents’ free time, creating added strain in the event of family health problems, including work-related injuries and illnesses. This commentary presents evidence about the impact of occupational injuries on today’s families. In addition to losing considerable income, injured parents are less able to do household work, and other family members are often called on to care for them. Family members cut back on their paid, school, and household work to fill in for the injured parent. This suggests the importance of policies to help today’s time-strapped families cope with major family health events. American Journal of Public Health 2005;95:1894 Y 1897.
J. AM. ACAD. CH ILD ADOLESC. PSYCH IATRY, 45:7, JULY 2006
889
Copyright @ 2006 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited.