I recently listened to an interview with author Abigail Shrier, whose first book promoted harmful myths and debunked theories about transgender youth and whose most recent work asserts that therapy is creating a youth mental health crisis. Though many of her claims in the interview were false or misleading, they highlighted some areas where we in the mental health field have not done a great job of communicating with the public, especially parents. I will be sharing posts on several of these topics in the next few weeks, beginning with one of the most troubling: youth suicide.
In the interview, Shrier described taking her pre-teen son to the pediatrician after an injury and being asked to leave the exam room so the doctor could complete a suicide screening with him. She expressed shock, noting that the screening involved explicit use of the word suicide and interpreting her exclusion from the process as undermining her parental authority.
Below, I’ll explain why a pediatrician would do this, but first I want to imagine Shrier in that moment. I have a lot of compassion for her as a mom wanting to protect her child. It is perfectly reasonable for a mom to say, “Wait! Why?” when the pediatrician proposes something that raises an alarm for her. However, because Shrier presents herself as a public expert on youth mental health and parenting, and shared this anecdote in the context of an interview promoting her book about the dangers of therapy for kids, she has a responsibility not to spread misinformation about youth mental health to other parents. It was clear from her comments that she did not ask her pediatrician or any medical or mental health professional for clarification about this practice she found so concerning.
We mental health clinicians ask such blunt questions: “Do you want to die?” and, “Do you think about killing yourself?” I can appreciate how shocking this might sound to a parent. However, this directness serves several purposes:
- It allows me to be as clear as possible. Indirect questions (e.g., “Do you ever feel hopeless?”) are confusing to kids and unhelpful for suicide risk assessment.
- It signals my comfort with the subject: talking about this is part of my job. Many young people who experience suicidality worry they will upset others by talking about it.
- If the child happens to be experiencing any kind of suicidality, it gives them terms to begin describing what they are feeling (e.g., “I kind of wish I was dead, but I don’t want to kill myself—is that weird?” or, “I don’t want to die, but sometimes all I can think is, ‘kill yourself’ when I’m upset—I’m scared one day I’ll do it…”).
Parents may worry that such directness will put ideas in a child’s head—in other words, talking about suicide might make an otherwise stable kid consider suicide. Research strongly shows the opposite: not only can we say with confidence that talking about suicide does not influence young people to become suicidal, we also know that talking about suicide with young people reduces risk.1 Kids are safer when their grownups have the courage to confront this difficult and painful topic.
Parents may also wonder why they are asked to leave the room for a suicide screening. I want to share the following with as much gentleness and compassion as I can. If your child is suicidal and has not told you, that is not evidence you have failed as a parent or evidence your child does not trust you. At the same time, if your child is suicidal and has not told you, it may be the case that your child is afraid of scaring, hurting, saddening, or angering you with this information—as misguided as those fears might be. It is frequently easier for a child to speak plainly about their suicidality with a healthcare provider who, while kind and caring, will not be devastated to hear, “I can’t stop thinking about killing myself.”
Finally, parents may wonder: what if a child feels intimidated or pressured by an authority figure, like their doctor, to affirm the questions on a suicide screening? Based on my experience conducting these screenings as well as my observation of other healthcare professionals, this is very unlikely. However, when adults communicate with kids, there is always a risk of misunderstanding. If a child were to infer that the “correct” answer was affirmative, and answered yes to the first screening question, the clinician would continue the screening and eventually determine the child was not at risk of suicide. For this misunderstanding to snowball into a genuine problem, a child would need to double down on their untruthful answer; describe a specific, lethal plan they intended to (and plausibly could) carry out; and continue to assert these claims with the clinician and their parents while the grownups discussed possible next steps (a safety plan for the home or hospitalization).
It is good for parents to ask questions and advocate for their kids, and it is crucial that we in mental health proactively communicate with the public. If you are a parent and have questions or concerns about the mental health screenings or treatment your child is receiving, you deserve to be heard and answered. If you have had negative, dismissive, or disrespectful experiences with a therapist (for yourself or your child), I believe you. Therapists are human, and the mental health field is a human project: we mess up, individually and collectively. My beef with Abigail Shrier isn’t that she criticizes therapists, it’s that this stuff is too important, and the stakes are too high, to waste time with manufactured outrage.
- Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychol Med. 2014 Dec;44(16):3361-3. doi: 10.1017/S0033291714001299. Epub 2014 Jul 7. PMID: 24998511. ↩︎
