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Question: Last week my 22 year old son tried to kill himself. He survived and now he claims he is ecstatic to be alive and he will never try something like that again. He wants go off his medication (his point is it clearly didn't prevent a suicide attempt) and he really does not want to go to therapy. He wants to handle it all on his own. He made a crisis plan with a therapist but I just don't feel like that is enough. What can I do?
Answer: Try to force a 22 year old to do something they don't want to and get ready for a colossal failure. Instead find out what does work for him and help him get greater access to that kind of support.
In general people do not make suicide attempts because they want to die, they want to escape from the pain they are in and they cannot concieve of any other way.
If we start with the postulate that overwhelming suffering leads to suicide attempts we have two goals: suffering management, suffering prevention.
It sounds like for your son the concept of therapy and medication = feeling weak and exposed. Most young men feel like accepting help makes them a failure in some way. If we cannot get him to change that feeling we must find out what other kinds of support we can surround him with that will work.
Many people struggle with weight loss because they assume it will mean denying themselves all the food they love, feeling hungry, and the kind of exercise that they equate with torture. When they learn that change does not have to equal suffering they can make great strides.
Talk to your son, find out which aspects of counseling he dislikes most and which ones he might be okay with. If he likes talking to friends but hates talking to strangers then help him make a list of which friends he can talk to about which issues. A major key to relapse prevention with any issue is having a person you are connected with who you can have 24 hour access to and tell anything. Even if your son was working with a therapist having a "sponsor" who he could, and would call if he was struggling is key.
The next step is to make sure that go-to person can handle the challenge and will call for help (even 911) if the situation overwhelms them.
People who will not consider medication need a physical method to produce some of the brain chemicals that will give them a boost. My first choice would be Yoga, and second would be any martial art. We want your son to have access to a soothing technique that can use a lot of energy and calm at the same time. We want something that he can do by himself at 3 AM because when people are alone and do not have access to their support network they are at the greatest risk for suicide attempts.
Jogging is a wonderful thing but if you try to do it in the middle of the night you get arrested.
In short, you should be nervous. No matter how good your son claims to feel right now he will feel overwhelmed again. You cannot force him to take supports he does not want so the best thing you can do is find out what supports he will take and use and give him as much of them as you can. Communicate with him and his support network regularly and look for changes in sleep, energy, mood. If you think something is wrong ask directly. You might risk offending him, but that is better than risking losing him.
The good news is if he can learn some coping skills that get him through the roughest times his suffering will always wane. Every hard times he survives will be a memory to help keep him afloat through the next bout of suffering. It may never become easy, but it does get easier as long as he finds the support that works for him.
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