ABSTRACT
Attempted suicide—the result of a conscious decision to kill oneself—rarely occurs before puberty but becomes a real possibility in the seriously disturbed person from puberty on. Many adolescents who talk of having thoughts of killing themselves say that they first had such thoughts at fourteen or fifteen years of age but rarely during childhood. A special meaning must attach itself to attempted suicide that is specifically determined by the onset of puberty. An action that is carried out with the conscious thought that it will result in one’s own death must be viewed very differently from other forms of self-inflicted injury. Many of the manifest pathologies of vulnerable adolescents carry some risk to their lives—anorexia, wrist slashing, compulsive involvement in dangerous activities, drug taking—but these forms of behavior do not include the conscious wish to die and therefore would not, from a developmental point of view, have the same significance for the adolescent. A suicide attempt, however minor, always represents a temporary loss of the ability to maintain the link to external reality and must be viewed as an acute psychotic episode. How-ever sane the adolescent believes he was at the time of the attempt, there is no objective reality attached to the idea of his own death. Instead the action is totally determined by a fantasy that excludes any awareness of the reality of his death.
