Bright, popular and apparently happy, Alice McGovern killed herself on the eve of going to Oxford. What were the warning signs?

Dying to succeed: Fatal pressure on our children

Alice McGovern appeared to have everything to live for. She was an able student with 11 GCSEs at grade A. She had good prospects of excellent results in her A levels and had already been offered a place at the academically prestigious New College, Oxford.
Her parents were both successful school teachers and her home life appeared to have been happy. She was described as having an optimistic personality and as being someone who looked forward to life. She had a regular boyfriend with whom she had an excellent relationship.
There was no history of family discord, rows or unfortunate incidents that are better forgotten and might provide embarrassment later. In fact, none of the common portents of suicide in able young people was present and Alice was even planning her forthcoming 19th birthday party in Oxford.
Life seemed to be set fair, but then last October she was reported missing, and was later found drowned off Beachy Head. Alice had left suicide notes that the coroner said clearly indicated an intention to take her own life. The letters expressed an absence of fear of death but a complete lack of desire to face life.
She told of her love for her parents and boyfriend, gave thanks for what they had done for her and explained that they were in no way responsible for her decision.

Suicide among young people — defined as the 15-24 age group — is becoming increasingly common. It is more often a cause of death in young men than young women, and the ratio of male to female is four to one. Conversely, suicide attempts in all age groups are more common in females.
In young adults, as in older people, there may be an underlying depressive or schizotypal personality that has remained undetected. Vague comments displaying an absence of faith in the ability or desire to survive life’s vicissitudes should always be taken seriously. Such comments as “I wish I had never been born” and “If only other people knew me as I know myself they would have a shock” should never be neglected.
The more conscientious a potentially suicidal person is, the less likely they are to tell other people about their fears. They consider such feelings a weakness and are loath to expose weaknesses, even to those they love most.
Whereas less obsessional and driven people are prepared to admit to a fear of change, an inability to live up to expectations, uncertainty about examinations (however unfounded), those who have already been successful don’t voice their anxieties.

The symptoms of depression in youth include all those found in older people such as loss of appetite, insomnia, feelings of hopelessness and an inability to look forward — none of these seems to have been present in Alice, or, if they were there, she kept them well hidden.
Higher achievers are always at greater risk than their more mundane contemporaries: they have higher standards to live up to and greater expectations to fulfil. Change is unsettling and the anxiety that they may not do well in an examination has brought down many an adolescent. For anyone who is sensitive and dislikes being judged, examinations are bound to lead to judgment and comparison. It is a myth that success always breeds confidence. It may do, but it may also set a standard that will seem impossibly difficult to live up to.
The super-conscientious with an obsessive streak in his or her nature is in greater peril of suicide than the pupil who trundles along a third of the way down the class, would be lucky to be in a team, let alone to captain it, and would never be considered a potential head of school. Later in life the youthful, eminent scholar or climber of Mount Everest may display vulnerability and an obsessive nature as well as determination and ability.

Without knowing the full history of Alice McGovern, it is impossible to speculate on the causes of her suicide but examinations, change of place of education or a house move, loss of friends or fear of loss of a boyfriend or girlfriend are all occasional motivating factors for it.
In young people quite unlike Alice, drugs, problems with the police, disasters leading to loss of self-esteem and ridicule as well as psychiatric disease are other risk factors.
When suicidal feelings in young people are associated with a depressive illness, the treatment is usually medication combined with cognitive therapy. If there’s any evidence of psychosis, a typical anti-psychotic will be essential. But in Alice’s case there was apparently no evidence of any psychotic behaviour, bipolar disorder or previous impulsive patterns of behaviour in her medical history.
Even so, her extreme detachment when discussing her own death, and perhaps evidence in her notes of a lack of appreciation of its likely impact on her parents and boyfriend, were significant. A casualness about death, whether one’s own or other people’s, can be an important psychological symptom.
Doctors are constantly confronted by the need to assess the seriousness of any expressed suicidal intent in a young person. When there is suggestion of this, however vaguely expressed, it has to be explored by an expert.

The long-term outlook will depend on any underlying psychiatric condition, for although medication used in conjunction with cognitive therapy may provide immediate help, it will have to be supported by family co-operation and reassessment of lifestyle.

Dr Thomas Stuttaford
4 August 2005

http://www.timesonline.co.uk/article/0,,8123-1719921,00.html

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