Beyond Carter verdict: Helping teens battle suicidal thoughts

The Carter case highlights an aspect of suicidal thinking that deserves more understanding, many experts say: Namely, that there is often ambivalence involved.

When a juvenile court judge in Massachusetts on Friday found Michelle Carter guilty of involuntary manslaughter – a crime that included encouraging her boyfriend to take his own life, even as he began to have second thoughts – the judge zeroed in on a particular moment of hope, a moment that might have changed the tragic outcome.

Ms. Carter’s boyfriend, Conrad Roy III, had found an instinct to live at a critical moment, interrupting the suicide attempt he and Carter had been discussing for days. Though suffering from a clinical depression, Mr. Roy stopped his attempt short. His girlfriend Carter, however, urged him to continue with the plan, and then did not tell anyone after he did.  

It was a case that unveiled the troubled lives of two teenagers who, though they lived far from each other, engaged in a vivid virtual relationship of texts and online messages. Both teens were suffering from depression and mutual despair, and their emotional tumult became the center of the case.

Legal experts continue to question the basis of the verdict of Judge Lawrence Moniz of Bristol County Juvenile Court, many pointing out the legal problems that could arise when words are deemed a criminal cause of suicide. However, those working to address the issue of suicide also point to Roy’s instinct to live at that critical moment.

Indeed, the case highlights an aspect of suicidal thinking that deserves more understanding, many experts say: Namely, that there is often ambivalence involved – a mixture of a desire to live and a desire to die, says Maureen Underwood, a clinical social worker involved with The Society for the Prevention of Teen Suicide.

It’s as if these people are “on a teeter totter,” and when they reach out, they need to be connected with someone who “lends hope to the hopeless,” Ms. Underwood says. Hotline workers or therapists give messages like, “I think there’s something we can do,” helping those contemplating suicide to feel less isolated or stuck.

In this case, Roy had reached out to his parents and had received help. He had also expressed some hope about plans for college.

“Where there is life there is always hope,” says Jennifer Powell-Lunder, a clinical psychologist who works with teens in Westchester County in New York. 

For teens who are thinking about this case, Ms. Powell-Lunder hopes one takeaway will be, when you have a friend considering suicide, “you cannot handle this on your own.... So many teens with good hearts think they can coach their friends through something like this” because they are egocentric and have the “illusion of invulnerability” at this stage of development, she says

In that pivotal moment, “[Carter] could have gotten him help,” she continues. “Can we say he would have accepted that? We’ll never know.”

Carter, who was 17 at the time, had indeed been urging Roy to seek treatment for his depression. Then, weeks before he took his life, as Carter herself was taking a new antidepressant medication, her encouragement abruptly changed course, and she repeatedly urged Roy to follow through with the suicide in her texts and online messages.

But it wasn’t the texting, said Judge Moniz. It was the phone call at the moment Roy was having second thoughts that constituted the “wanton and reckless conduct” that helped cause his death.

As a public health issue, suicide remains one of the world’s greatest public health issues, experts say. In the United States, there were more than 41,000 deaths from suicide in 2013, compared with 15,800 total homicides and 35,200 traffic fatalities, according to the Centers for Disease Control and Prevention.

“Yet for every depressing thing, we have a hopeful counterpart,” says Kelly Posner Gerstenhaber, founder and principal investigator at the Columbia Lighthouse Project  at Columbia University-New York State Psychiatric Institute, noting that, with the right intervention, suicide is the most preventable public health threat.

“Really, there is the simplicity of the power of asking, and its potency,” says Dr. Posner, who has created a widely used severity risk assessment scale, working with the US military, states like Utah, and even gun rights groups, since more than 60 percent of all gun deaths are suicides, according to Pew Research. Her assessment questionnaire has won wide praise for lowering suicides.

Some experts have pointed to the role texting and online messaging played in the relationship, finding that the case fits into a pattern of growing concern about how constantly-connected young people have lost touch with a deeper, truer intimacy.

“If you’re active on seven or more media apps, you’re more likely to be clinically depressed than people who [are not]” notes Dr. John Huber, who heads Mainstream Mental Health, a nonprofit in Austin, Texas, citing recent data. Anecdotally, he sees in his own practice younger Millennials who are “losing that connection, being on social media, between them and the real human beings standing next to them.” He says he doubts Carter would have encouraged Roy to follow through with his suicide in a face-to-face conversation.  

But preventing suicides mostly depends on pro-active efforts to identify those suffering and offer treatment, Posner says.

“So we should be asking these questions the same way we monitor for blood pressure,” Posner says. “Identification has to be the first key to prevention. We have to find the people suffering in silence to get them the help that they need.”

If you are in crisis please call the National Suicide Prevention Lifeline at 1-800-273-Talk (8255) or text TALK to 741-741.