Presentation at the 19th World Congress on Viktor Frankl's Logotherapy, 2013, Dallas, TX, USA

1. Self-Destructive Behavior
and Suicide Prevention in
Adolescence
AN EXISTENTIAL AND MEANING-CENTERED PERSPECTIVE

2. Timo Purjo timo.purjo@nfg.fi
© Timo Purjo
 Doctor of philosophy (philosophy of education, ethics, value
education), University of Tampere, Finland
 Diplomate Educator in Logotherapy, Viktor Frankl Institute of
Logotherapy
 Founder, Vice-Chairman and Director (R&D) of Non Fighting
Generation (NGO), Finland
 Faculty member of the Viktor Frankl Institute of Logotherapy
 Chairman of Friends of Viktor Frankl Institute ry, Finland

3. Outline
1. Introduction
2. Research questions
3. Method/key literature
4. Findings
5. Discussion/conclusion
6. References
7. Time for questions
© Timo Purjo

4. 1. Introduction
 What keeps us alive in times of suffering?
 Remarkable in Frankl's work and philosophy: ability to
develop such an unconditionally positive view of life in
spite of the suffering he confronted through his work
with suicidal patients and through his own trial in the
Nazi concentration camps.
© Timo Purjo

5. 1. Introduction
 Presentation based on research and experiences in Finnish youth
education organization Non Fighting Generation: specialized in
helping violently behaving young persons since 1996
 Recently 3-years research project on the subject of suicidal and
self-destructive behaviors of young people (adolescence acting
violently against themselves), in co-operation with National
Institute for Health and Welfare (THL)
 Now started a new 3-years project in Finland, also with THL, in
which all gathered theoretical knowledge is being put into
practice
© Timo Purjo

6. 1. Introduction
 Target group 13-25-years old adolescents and young adults who suffer
from experiences of lovelessness, meaninglessness, and despair,
and who also have symptoms of some kind of self-destructive or suicidal
tendencies
 Aim of the project
1) to anticipate and prevent youth suicides and all kinds of self-destructive
behavior as early as possible (at least before a first suicide attempt);
2) to encourage self-destructive adolescents to find, despite their
disturbances and difficult life situations, some valuable point of
references to themselves, to their lives, and to the world around them;
3) to promote meaningful experience in their lives
© Timo Purjo

7. 1. Introduction
© Timo Purjo
 Means
 to develop existential and meaning-centered methods for
youth suicide and self-destructive (a) risk assessment, (b)
short-term intervention, and (c) longer-term individual
counseling and support based on a logotherapeutic approach
for the use of health workers and psychiatric nurses working in
schools and public health centers

8. 2. Research questions
Focus of the presentation
© Timo Purjo
• To discuss the phenomenon, i.e. the self-destructive and suicidal
behaviors of young persons
• To introduce some of the basic principles and viewpoints of our
existential and meaning-centered approach in preventing young
person’s suicides
• To examine research on risk factors as well as protective factors
for suicidal behavior in adolescence
• To analyze critically the currently dominant view of self-
destructive behavior and its prevention and treatment

9. 3. Method/key literature
• Key literature: 32 articles, 5 books
• The paper (Pyry Hannila & Timo Purjo) and/or bibliography
available upon request: pyry.hannila@nfg.fi, or
timo.purjo@nfg.fi
© Timo Purjo

10. 4. Findings
Suicidal and self-destructive behaviors
• Occasional thoughts of death or suicidal ideation are common
and normal. In adolescence, the suicidal thoughts are often
related to current difficulties. Milder, transient suicidal ideation
without suicidal plans does not usually involve a conscious
desire to die; however, behind these thoughts there may be an
unvoiced wish that a difficult situation or state of affairs would
get better. Instead, recurrent or persistent suicidal thoughts or
plans have more a serious character — especially if the ideas
are related to a suicide plan or a strong desire to die.
© Timo Purjo

11. 4. Findings
Suicidal and self-destructive behaviors
• Worldwide life-scale prevalence of suicidal ideation is about 9%, and
suicide attempts about 2.7%. Age is negatively associated with
suicidal behavior; that is, young people and young adults are
strongly represented in suicidal behavior. Evans et al. (2011)
investigation indicates that up to 30% of young people have thought
of committing suicide and about 10% have attempted suicide.
• Some studies suggest that up to 17% of the people harm
themselves during the life course (Whitlock et al., 2006).
Furthermore, non-suicidal self-injury increases the risk of suicide
(Hooley, 2008.) Non-suicidal self-harm is particularly common
among young people. In Western countries, 5-9% of young people
harm themselves each every year (Skegg, 2005).
© Timo Purjo

12. 4. Findings
Suicidal and self-destructive behaviors
• In one Finnish study (Laukkanen et al., 2008), up to 11.5% of
young people aged 13-18 had harmed themselves. In particular,
young women appear to be at risk in this respect: Female’s self-
harm figures are up to eight times higher than those of males,
however, in adulthood, the gap narrows considerably between
the genders (see Hooley, 2008).
© Timo Purjo

13. 4. Findings
Research on risk and protective factors for
suicide and suicidal behavior in adolescence
• Research on risk factors for adolescent suicide provides the
basis for suicide prevention. The vast majority of research on
suicide risk and traditional suicide risk profiles has focused on
negative factors that predict suicide attempt risk and increase
the chances of an individual engaging in deliberate self-harm.
• Current research with adolescence has found that (1) previous
suicide attempt, (2) presence of a mental disorder (especially
mood disorders), and (3) presence of substance/alcohol misuse
constitute the most prominent risk factors for completed suicide.
© Timo Purjo

14. 4. Findings
Research on risk and protective factors for
suicide and suicidal behavior in adolescence
• Recent research evidence in China, based on psychological
autopsy studies of suicide decedents, have indicated
substantially lower rates of mental disorders in Chinese suicide
victims compared with those in respective Western studies
(Phillips, 2010; see also Pelkonen et al., 2011).
• As Pelkonen, Karlsson and Marttunen (2011) have pointed out,
this may have important implications for both the theoretical
modeling of suicidal behavior and the development of suicide
prevention strategies — especially given the fact that China
accounts for as much as 1/3 of global suicides.
© Timo Purjo

15. 4. Findings
Critique of current theoretical model of
suicide prevention
• Marsha M. Linehan (2008) has stated, ‘the central theory of suicide
and suicide prevention that has shaped suicide prevention research
to date contends that suicide is a symptom of a mental disease and
prevention of suicide requires treatment of the underlying disease’.
• Yet, none of numerous published randomized clinical trials, which
have investigated interventions for depression, substance abuse, or
schizophrenia – disorders commonly associated with suicidal
behaviors – have not shown that reducing the symptoms of mental
disorders would also reduce the incidence of suicide attempts or
suicide. Moreover, treatments targeting suicidal behavior alone have
been much more effective than those targeting presumed underlying
mental disorders.
© Timo Purjo

16. 4. Findings
Critique of current theoretical model of
suicide prevention
• Utilizing a complementary approach, suicidal ideation, suicide
attempts, and completed suicides are not reduced to the symptoms
of mental health problems (e.g., depression). Instead, Linehan
(2008) contends that suicidal behaviors should be conceptualized as
‘dysfunctional and disordered individual and social behavior’.
• From this point of view, self-destructive and suicidal behaviors could
be conceptualized as inability to cope with life demands as a result
of lack of sufficient individual and social resources. This different
approach to suicide risk assessment, which has been studied during
the last three decades, has been conceived mainly as a result of the
development of the Reasons for Living Inventory (RFL; see e.g.,
Linehan et al., 1983).
© Timo Purjo

17. 4. Findings
Critique of current theoretical model of
suicide prevention
• While most studies have focus primarily on negative risk factors, RFL has
been developed to investigate the factors that protect and prevent
individuals from committing suicide, and inspire them to live in the face of
hardship and adversity. Linehan and colleagues (1983; 2007; 2008)
emphasize that suicidal compared to non-suicidal individuals lack positive
beliefs and expectances in life and have fewer concerns regarding the
consequences of suicide for their social environment.
• Linehan and colleagues have identified six reasons for living. Individuals who
possess these reasons for living (e.g., “I believe I can find other solution to
my problem” and “I have courage to face life”) reflected in the inventory are
hypothesized to be less likely to attempt suicide than those who do not. This
hypothesis could play an important role in understanding suicide risk.
© Timo Purjo

18. 4. Findings
Critique of current theoretical model of
suicide prevention
• Having more reasons for living differentiates between those who do not
have a history of suicide attempt and those who do — despite comparable
severity of mental health problems and recent adverse life events.
• Emphasis on reasons for living is also consistent with an existential and
meaning-centered approach to understanding suicide in which the
emphasis is placed on human strengths and well-being rather than on
emotional vulnerability and symptoms of mental health problems. From
an existential and meaning-centered perspective, it is particularly
important to investigate these positive factors — the strengths and
resiliency — that help to protect and prevent person from suicidal
behavior in spite of mental health problems or stressful circumstances
that can lead to despair.
© Timo Purjo

19. © Timo Purjo
4. Findings
An existential and meaning-centered
approach to young person’s suicidality
Between stimulus and response
there is a space.
In that space is our power
to choose our response.
In our response lies
our growth and our freedom.
(Viktor E. Frankl)

20. • What is ‘suffering’, after all?
• From an existential point of view, different kind of mental health
problems, substance misuse or abuse, extremely stressful life
events, or self-destructive behaviors, can all be understood as
the manifestations of the larger human phenomena — frustration
in the search for meaning (‘existential frustration’), feeling of
inner emptiness (‘existential vacuum’), and meaninglessness.
Suffering without meaning leads to despair, as Frankl has stated,
and despair caused by these kinds of devastating destinies or
functional disturbances, may lead to such a crisis where a young
person can’t find a way out but by suicide.
© Timo Purjo
4. Findings
An existential and meaning-centered
approach to young person’s suicidality

21. • Viktor Frankl’s book, Man's Search for Meaning, ends with a Chapter
on Tragic Optimism. By the use of this term Frankl expresses the
view that everything can be taken away from a human being, except
the last area of freedom — the freedom to choose one's attitude
towards unavoidable circumstances. Thus, our existential and
meaning-centered approach does not concentrate so much on the
background of the suicidal behavior (e.g., above-mentions risk
factors) but instead to an individual’s distinctive possibilities as a
person.
• What does this mean from a practical point of view in treating a
young person who has some suicidal tendencies?
© Timo Purjo
4. Findings
An existential and meaning-centered
approach to young person’s suicidality

22. • One of the central issues in working with suicidal adolescents is their self-
centered focusing on deficits, disturbances, and problems in their life and
in themselves, which diminishes any positive aspects and hinders their
ability to create some distance between themselves and their problems.
• However, even a high risk person is always more than their disturbances,
problems, incapacities, or self-destructive behavior. That is one of the
reasons why suicidal adolescents should not be approached through their
deficits or derangement. Furthermore, when a young persons gets caught
in this kind of a vicious circle of rumination and identifying themselves
with these negative attributions and adverse symptoms, it can make their
situation even worse (Morrison & O’Connor, 2008; Miranda et al., 2013).
• Frankl calls this state hyper-reflection.
© Timo Purjo
4. Findings
An existential and meaning-centered
approach to young person’s suicidality

23. • Hyper-reflection can be counteracted with de-reflection, which helps one
to redirect their attention from problems to unique meaning potentials
life offers from moment to moment. This technique is based on the self-
transcendence, the human capacity to become directed to something, or
someone, other than itself — be it a meaning to fulfill or another human
being to encounter lovingly. Furthermore, although some people have
the intuitive capacity to resort to their inner resources and power of will
challenging life circumstances; in preventing youth suicides, it is
extremely important to help adolescents to become aware of and
develop their defiant power of the human spirit, so they can overcome
their biological, psychological, or sociological limitations, and resist their
disfavorable abilities, circumstances and experiences—to the extent that
they can permanently avoid getting assailed by such destructive forces.
© Timo Purjo
4. Findings
An existential and meaning-centered
approach to young person’s suicidality

24. • An aid and support should not either stop at the point when the acute
crisis has passed; on the contrary, there is so much more that can be
accomplished. Crisis is always both a threat (to freedom) and a
possibility (for growth). Once the threat has passed, one can begin to
take advantage of all the opportunities the crisis has provided. In
logotherapeutic healing the target is not only to restore one’s pre-crisis
operational capacity, but to find ways to enjoy a more meaningful and
purposeful life for the future (Long, 1997). Thus, the fundamental
purpose of intervention is help those in distress become people who
are able to intuitively activate their defiant power of the human spirit
in the face of crisis and maintain the sense of meaning and purpose in
spite of adverse circumstances
© Timo Purjo
4. Findings
An existential and meaning-centered
approach to young person’s suicidality

25. © Timo Purjo
4. Findings
An existential and meaning-centered
approach to young person’s suicidality
Stage 7
“Transcending the Trauma”
Stage 1
Current Level of Stage 6
Functioning Return to Previous
Stage 2 Baseline Level of Level of Functioning
Onset of Crisis Functioning
-------------------------------------------------------------------------------------------------------------------------
Stage 3
Rapid Descent Stage 5
into Despair Progressive Improvement
during Clinical Intervention
Stage 4
“Bottoming Out”
Long, Jerry L. Jr. (1997) Logotherapeutic
Transcendental Crisis Intervention,
The International Forum for Logotherapy,
20 (2), 104-112.

26. 5. Discussion/conclusion
• Existential issues, like meaninglessness, are a central part of suicidality.
Anton Nindl (2004) has stated: the ‘question of meaning is the one we
have to confront again and again while working with suicidal people’.
Meaning-centered approach, which emphasizes the spiritual side of
human being and the significance of meaning in life, brings a fresh
perspective to mental health treatment and etiological examinations.
• When adolescents indicate that they find that suicide is the only
possible route out of suffering, focus should be on keeping them alive
by providing hope and meaningful reasons for living. However, this
should not be based on false promises or empty hopes but on a
dialogue which reveals to a young person that there is some
meaningfulness in world, positive reasons for living, and something
valuable in oneself.
© Timo Purjo

27. 5. Discussion/conclusion
• In suicide prevention, it is a question of the spiritual empowerment of
a young person, which is guided to finding life as meaningful through
the defiant power of the human spirit and acts of self-transcendence.
• Concentrating on the healthy aspects of individual and the
possibilities that are still available, regardless of adversities and
handicaps that constrain a person’s life, makes it also comforting:
There is no situation without any hope, and there is no one
who could not reach for the possibility of a meaningful life
© Timo Purjo

28. 6. References
• List of sources available upon request:
pyry.hannila@nfg.fi, or timo.purjo@nfg.fi
© Timo Purjo

29. 7. Questions?
You may also contact us later-on:
Project Coordinator and Method Developer Pyry Hannila,
pyry.hannila@nfg.fi, or
Director (R&D) Timo Purjo, timo.purjo@nfg.fi
© Timo Purjo