I Had My Son Admitted to a Mental Health Facility

Reader’s Question

A few days ago, I had my 16-year-old son admitted to a mental health facility after he expressed to me that he had been having suicidal thoughts. My husband and I told him that we were proud of him for telling us and explained that we felt it was best to have him admitted. My son went willingly and on the way to the hospital he made some disturbing comments. He stated that he has killed 7 cats (years ago) and that he has more homicidal thoughts than suicidal thoughts. When I visited with him yesterday, he said that if there was a day of no consequences, there would be dead bodies everywhere and that he thinks he would feel relaxed and relieved after committing a murder. He says that he has played it out in his head.

The therapist has given me the impression that she thinks it’s nothing more than depression and it’s completely normal to sometimes have homicidal thoughts when you have depression. She also said because he is not really outwardly aggressive (hasn’t started many fights), she is pretty confident it’s related to the depression. My son has always been dark in a sense and been very interested in death as long as I can remember. My concern is that it’s as if he is curious about committing a homicide and that is beyond frightening to me. I have a very hard time processing that this death obsession is merely due to depression. It almost seems as though he is showing signs of being a sociopath. He even used that term in reference to himself.

Here’s a list of signs that I have noticed: curiosity about death/homicide, manipulative, harming animals, playing with fire, property destruction, lack of follow through, isolation, had a bed-wetting problem until he was about 11 or 12, loner for the most part, no compassion, irresponsible (can’t finish chores or schoolwork).

What do I do? I am appalled and disgusted but yet can’t turn my back on my child. However, I have other children and need to know that they will not be harmed by him, first and foremost, nor do I want to see him cause harm to anyone else…or anything. Any feedback would be greatly appreciated.

– Shell-Shocked Mother

Our Clinical Psychologist’s Reply

Depression can include both suicidal and homicidal thoughts/fantasies. As you describe, however, your son’s preoccupation with death and inappropriate behavior was present before the current depressive episode. I suspect the stress of the depression has brought these fantasies and preoccupations to the surface and to clinical attention. Depression and stress amplifies our existing personality — making obsessive-compulsive individuals more OCD, shy people more withdrawn, that kind of thing. The mental health intervention has clearly brought his psychological status to your attention and the attention of the professionals. As your son reports, it has also brought his thoughts and behaviors to his attention. Your son is now concerned with his psychological status and may be confused about what to do.

Adolescents normally have fantasies of all kinds that if revealed, would prompt their parents to age about ten years overnight. As teenagers, they have no way of knowing if such fantasies and/or behaviors are “normal” and for this reason, keep their thoughts, feelings, and behaviors very private. Teenagers who are shy, introverted, or socially withdrawn have more difficulty with this as they rarely “compare notes” with other teens. When depressed, these thoughts/behaviors/feelings are often revealed in a single presentation — shocking parents and even the adolescent.

The therapist is correct in two major themes — 1) this is common in depression and 2) there is little evidence of expressed aggression/violence. However, I think we must be more sensitive to your son’s personal report and feelings he may be a sociopath. Obviously, this is more than depression, and I suspect your son has been gradually emotionally overwhelmed by his internal thoughts, feelings, and fantasies. This is clearly more than a routine depression. Your son has been heading this direction for a while now.

What do we do as parents?

• Focus on an aggressive mental health treatment program, not just routine counseling or post-hospitalization follow-up.
• Arrange for a weekly therapist — someone who is a good fit for your son. He needs a therapeutic relationship — not someone to provide suggestions.
• Consider a psychiatric consultation.
• Remind your son that he is in a treatment program and encourage him to be open and honest with those working with him.
• If he is prescribed medications, remind him that some medications may actually briefly increase thoughts of self-harm. If he experiences increased suicidal/homicidal thoughts, he should report that immediately.
• Remove all firearms from the home or secure them if necessary.
• Encourage your son to participate in activities that build social skills. I suspect he may be a teenager who has too much “inner thinking” for his own good. He needs to focus on what’s outside rather than inside his head.

Family counseling can also be helpful in these situations. Family counseling acknowledges that the entire family is involved and can become a therapeutic environment. Your son is going though a difficult passage and so far, you have taken the right steps and are asking the right questions. You are also appropriately concerned that his feelings and thoughts are not minimized by grouping them all under a label of depression.