Editor's note: This is the final article in a four-part series
exploring the issue of suicide and suicide prevention in the military community.
VICENZA -- The depression and anxiety started when she was in eighth grade, and it was accompanied by a disturbing symptom -- cutting herself.
"I had been diagnosed with anxiety and depression, and with that came the self-harm. It was very hard to hide from my parents," she said.
Although cutting or self-harm can mean someone wants to die by suicide, in the case of this teenager, it was more about release from the tension of anxiety and depression, she said.
"Cutting isn't often associated with suicidal behavior, but I am finding that with a lot of these kids who have suicidal ideation, they're also cutting as a way to deal with their stress, (so) that can be a warning sign," said Mark Gillett, school psychologist at Vicenza High School.
While she was on antidepressants and anti-anxiety medications, the side effects were causing problems.
"With the anxiety, I was feeling like, 'I'm never going to get off medication. I'm never going to feel better.' Even on the days when it was better, it was still very difficult for me to function like a normal human being," she said. "I felt like I was almost robotic with my medication, and of course that's different for everybody. But it just completely shut me down."
In her junior year, she reached a breaking point when she considered suicide.
"It was a Sunday night … I'd gotten to the point that night where I was like, I really want to. I want to try, but I don't want my parents to find me like that, in my bathroom at two o'clock in the morning," she said.
She cut her arms.
"I thought, I don't need to graduate. It'll be better this way. It wasn't so much that my friends and family won't miss me because I knew very well that they would miss me, but it was a sense that I wondered if they would understand that being alive and hurting is not the same as hurting for somebody who was alive," she said.
The cuts weren't deep enough to warrant emergency treatment, and she didn't even tell her parents.
"That next day, I felt like I had to tell my best friend something because she could tell that I was very off, and I told her, 'I did something very stupid last night,'" she said.
That behavior is typical with children and teenagers.
"The hard thing is, kids are going to tell their friends," Gillett said. "That's usually how I find out. A friend comes to me. They're not going to tell an adult, so that makes it more difficult."
After she shared with her friend and authorities were notified, the student ended up in the Behavioral Health clinic.
"Of course, my mother was devastated because she thought I was past that. It was weird because we were sitting in the clinic in Behavioral Health, and they were trying to figure out what to do with me. She asked me, what could I have done?" the student said.
"There is nothing that (she) could have done. It was just something that happened in the moment.
It was very impulsive. I was taking my medication like normal," she said. "It was very surreal. I was dazed."
She recognizes now that part of the reason why she ended up in such a dark place was the feeling that because she was young, she wasn't supposed to struggle.
"Adults say, you don't know what it's like to live. You don't know what it's like to experience tragedy. You don't know what it's like to have bad things happen to you. It was that that kept me from letting anything out," she said.
The tendency of adults to minimize the suffering their children are going through is something to be guarded against, said Samantha Locke, Adolescent Support and Counseling Services counselor at Vicenza High School.
"As adults, we have to recognize that to them, it is everything. Coping with that friend who just betrayed them or broke up with them or said something -- that's the first time that they've had to deal with something like that," Locke said. "They can't deal with paying their mortgage and dealing with their boss and picking a spouse and raising a kid until they learn how to deal with their peer drama. It's the stepping stone, just like we don't come out of the womb and start walking."
As a self-described perfectionist, part of the anxiety the student felt was that she was a failure.
"You feel like you have to deal with this alone because you're a failure. Your parents don't want you to have anxiety and depression," she said.
That anxiety is a common component for teen suicidal ideation.
"Often, the kids I see who have that ideation, who are considering, it's about being overwhelmed more often with an adolescent population," said Locke.
"There is depression in there, as well. And depression can look different. It can be more aggressive in children. Depression may be a component in what's making them feel overwhelmed, but there's usually other components as well.
"But when someone is at the point where they're breaking, where it doesn't seem like they can go any further, nine times out of 10, that's a feeling of being overwhelmed. That 'it can't get any worse than this.' That can take the look of somebody who's sad and isn't able to cope with their sad feelings, but it could also be like some of these kids who are very anxious. Our population of young folks now are much more anxious than the populations we've seen before."
That anxiety can be even more pronounced in a military community.
"(This generation) has always known war. We've always been a country in conflict for them," Locke said. "They're growing up with conflict and financial instability … In the military, we see more employment stability, but the military kids know a lot more about how much of an instability everything else is."
The student's suicide attempt was a wake-up call.
"It was a cry for help, but for myself. I wasn't looking for anybody else's attention. It was for me," she said. "I need to realize what I'm doing. I can make it past this, but how am I going to move on past this point?"
With counseling and support from family and friends, she has been able to move on and graduated from high school in June.
"I'm so happy I didn't go far enough with it that something happened," she said. "I spent most of my recovery process … reflecting back on how much I have to look forward to. I think that reflecting on that and knowing that it could get that bad again, but pushing forward, is keeping me from going back to the dark place. It made it worthwhile."
For parents who are concerned that their teen may be struggling in that way, recognizing the problem in the first place is crucial.
"For parents, communication (is key) -- being aware that something is different, awareness of what's normal in an adolescent," Locke said. "Knowing what's normal for teens is the first part, knowing what's developmentally appropriate. And then the other piece is, (knowing) what's normal for your teen."
And teens don't always feel comfortable communicating with parents.
"They're at an age where they're learning to detach from us as parents and detach from our family system in creating their own independence. So, by nature, they're not going to confide in you as much. They're going to look for somebody else," said Locke.
Realizing that is key for parents in getting help for their children. There are a variety of resources available to teens and their parents -- counselors in the schools, ASACS counselors at the middle and high school, Military Family Life Counselors, school nurses and the Behavioral Health Clinic.
Another source that the student found helpful can be controversial.
"I think there's a stigma, that people are more in touch with their phones than other people, but sometimes that's the only way people can get help for the situation they're in," she said. "I have a lot of friends who turn to the Internet because they felt like they could connect more with complete strangers than they could with family."
Both Locke and Gillett cautioned against parents blindly trusting teens with their social media and phone usage.
"Parents need to watch whom they're talking with and when," said Gillett.
Parents here may be reluctant to seek help because they fear being sent back to the United States for help.
"They're not going to go back home just because the kid is suicidal. Actually, not reporting is going to increase your chances of being sent back," Locke said. "Typically, these families do not have to be re-routed to the United States. It can often be handled in-house. Over 50 kids last year had to be evaluated for suicidal ideation. Three went back to the States. Two (of those) made the choice to go back."
For teens who are struggling, the student has a message.
"It's better to move forward and help yourself … You have people who love you," she said. "It's better to face it head on than to just suppress it. You're not a burden for having a mental illness. You're not a burden for self-harming."
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