Archives of Suicide Research

ISSN: 1381-1118 (Print) 1543-6136 (Online) Journal homepage: http://www.tandfonline.com/loi/usui20

A Case Study on Adolescent Suicide: Tim

Christianne Esposito-Smythers , David A. Jobes , David Lester & Anthony

Spirito

To cite this article: Christianne Esposito-Smythers , David A. Jobes , David Lester & Anthony
Spirito (2004) A Case Study on Adolescent Suicide: Tim, Archives of Suicide Research, 8:2,
187-197, DOI: 10.1080/13811110490271380

To link to this article: http://dx.doi.org/10.1080/13811110490271380

Published online: 12 Aug 2010.

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 Archives of Suicide Research, 8:187^197, 2004 ISSN: 1381-1118 print
Copyright # International Academy for Suicide Research DOI: 10.1080/13811110490271380

A Case Study on Adolescent

Suicide: Tim
Christianne Esposito-Smythers, David A. Jobes, David Lester,
and Anthony Spirito
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A case of an adolescent suicide is presented through an interview with his

mother. Two Commentaries follow discussing the psychodynamic and
diagnostic aspects of the suicidal development from a suicidological
perspective.

Keywords adolescent suicide, mood disorder, conduct disorder, self-loathing,

survivors

M ost case studies of suicides that are

presented in scholarly journals are
summarized by the mental health profes-
sionals who evaluated or treated the client
and are, therefore, a¡ected by the orienta-
tion of the clinician. The present case study
is based on an interview with the mother
of an adolescent suicide, the type of pri-
mary data that is provided in a psychologi-
cal autopsy. The interviewer was told that
Tim’s mother was willing to talk about her
son’s suicide, and so he contacted her to
request an interview with her. The inter-
view was video-taped for use in his
courses.1 The commentators, both experts
on adolescent suicide, were given the com-
plete transcript of the interview and so
were able to view this primary material
rather than a report from a clinician ¢ltered
through that clinician’s biases. They were
asked to comment on the case in whatever
way they wished.
Tim was 17 years old when he killed
himself using car exhaust. He had not pre-
viously attempted suicide. He left no sui-
cide note. Tim was the middle child of
seven. The following presents several
extracts from an interview with his mother
conducted several years later.
INTERVIEW
Jane: He [Tim] had been away for two days
on a camping trip with some friends
of his. He was due to come back in the
afternoon or early evening of the
night that he died. I received a call
from my mother-in-law late that after-
noon. Tim’s father has a country place
outside Jonesboro, Pennsylvania.
Tim and his friends had gone up there
and vandalized the place. They had
ripped it to pieces; torn up things that
would have no real value to anyone
but his father. My mother-in-law hap-
pened to be going there, and she
walked in on them. The boys ran
away. She noti¢ed the police. Then

1
Tim’s mother hoped to help others in similar situations and to give a meaning to Tim’s suicide. The
interviewer’s goal was to obtain primary source material for use in his teaching.

187
 An Adolescent Suicide
she became apprehensive and remor-
seful, and she thought that maybe she
shouldn’t have noti¢ed the police. So
she called me. I told her that she was
right to do it. Then Tim called me on
the way home, and I said to him,
‘‘I talked to Nanny and I know what
happened.’’ I worked nights at the
time, and I said, ‘‘If I’m asleep when
you get home this evening, you wake
me because we are going to talk.’’ He
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said, ‘‘Yes, all right.’’ When I woke
up that evening, my other children
told me that he had come in, had
something to eat, borrowed my foster
daughter’s car, saying he would be
home early and not to bother me. He
would talk to me later. I went to
work, and I knew something was
wrong. That is the only way I can put
it. The idea of suicide never entered
my head. Never. But I knew some-
thing was radically wrong. I called the
police, and they told me that they
could not look for him until 24 hours
had passed. But they said if Tina, my
foster daughter, would declare her car
stolen, then they could look for him. I
called her up and told her to do it . . .
So the police came to the apartment
to interview her. This was about one
o’clock in the morning. She described
her car, and they said ‘‘Well, that car is
in the parking lot.’’ She said, ‘‘It can’t
be because, whenever he parks my
car, he brings me the keys.’’ ‘‘Well it’s
there.’’ And she said, ‘‘Something is
wrong.’’ She went out with them, and
they found him. He had taken a piece
of garden hose and threaded it from
the exhaust through the window.
David: He never talked about suicide?
Jane: Never to me. I found out later that,
to several of his friends and his older
brother, he had said that he had con-
sidered it, that it was the ultimate
answer, that, if things got to where
he absolutely couldn’t handle them,
188 VOLUME 8  NUMBER 2  2004
he’d get out of it. It was the ultimate
running away because nobody could
bring you back.
David: What was Tim like as a child?
Jane: Well up to the age of about eleven,
he was a super sweet child, very
sweet, very loving. Totally domi-
nated by his older brother. His older
brother led him around by the nose.
They were like the Chief and the
Indian. Everybody adored him, and
he was just sweet and lovable, a little
chubby cute kid. Then when he was
about eleven he shifted into high. He
started getting into all kinds of trou-
ble at school. But it was nothing but
silly trouble, cutting up, silly trouble.
Then we moved up to North Jersey.
I think he was about eleven. And
then he started really getting into
trouble. He set a couple of ¢res, he
vandalized quite a bit, and he began
to steal. When we would ask ‘‘Why?
Now just tell my why,’’ he would
say, ‘‘I don’t know.’’ And I honestly
believe he was telling the truth.
David: What did he do before you moved?
Jane: Well it was just silliness. Like the tea-
cher would go out of the room and
come back and ¢nd him tap dancing
on a desk. Sticking bubble gum
where bubble gum didn’t belong.
Silly childish things. Like ‘‘Look at
me. I’m going to make you laugh.
I’m a clown.’’ It wasn’t any real
harm. It was a nuisance more than
anything else.
David: After you moved it began to get
bad. What did he set ¢re to?
Jane: Once, there was some type of enter-
tainment going on in school. He
went to it with a bunch of others,
and they went outside during an
intermission. He lit a spill or some-
thing and tossed it under a parked
school bus. Apparently somebody
managed to put it out just before it
was going to take the gas tank up.

He had no idea what would happen.
He was just being stupid. Another
time, he set a ¢re in a classroom.
They were doing something with
rubber cement, and the teacher had
the imprudence to leave the room for
a minute. He set ¢re to that. He
swore on a stack of Bibles he didn’t
do it. But he did. Then another time,
riding home from school on the
school bus, he and another kid just
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carved up the whole back seat. Of
course, we got the bill for that.
Which was only right.
David: The night that he killed himself,
was that the ¢rst time he had
destroyed something that belonged
to a relative?
Jane: Just before he died, the father of a
girl was redoing her bedroom, and
he had been putting aside money a
little at a time so that he had about
one thousand dollars on hand. Then
he was taking the money and buying
the things that he needed. She was
telling Tim how pretty her room
was. I don’t remember whether she
took him in and showed him or
whether she told him. But at any rate
her father kept the money in a desk.
Tim went in there (this was just a
day or so before he died), pried open
the desk, took nothing out of it, and
went out the window. They know it
was him because, if you please, he
left his knife with his initials on it.
He wasn’t stupid. It had to be saying
something. We tried so hard to ¢nd
out and we failed.
David: Did he steal money?
Jane: Yes.
David: Did he steal things that he needed
or just anything?
Jane: It was anything. For example, I was
doing some work in the house with
some wood. I was carving this piece
of wood, and he said, ‘‘You are going
to tear your hands up with that. I’m
ARCHIVES OF SUICIDE RESEARCH
C. Esposito-Smythers et al.
going to see if I can ¢nd you some-
thing that would be better.’’ A day or
two later he brought me this wood-
working tool which was really nice. I
just said, ‘‘Thanks.’’ If I had thought
about it, I would have thought he
had bought it. He had jobs here and
there. He earned money, and he was
generous. I never even thought about
it. It turned out he had lifted it from
school. So when that was brought
home to him, I shook down his bed-
room and pulled the other things
out, and we took it back to school. I
said to him, ‘‘Why?’’ He said, ‘‘Well,
I thought you could use it.’’
David: So he stole generously, to give to
other people too?
Jane: Yes, and he stole for himself.
David: Did he have enough money that he
didn’t have to steal if he needed
those things?
Jane: Oh yes. He always had jobs.
David: Were there any other behavior pro-
blems he showed beside this steal-
ing and destruction?
Jane: A great deal of violence. He had
immense mood swings. They were
like that (snap). They swung one
way, and they swung the other and,
when he was in a rage, you had
just better get out of the way. He
would lay you out. He didn’t care
who you were or what the situation
was. He thought the world of his
younger brothers, but they got put
through the wall and he really let
them have it.
David: What situations would make him
angry?
Jane: Anything. Here is one example. His
older brother was using my car for
some errands, and he parked where
he wasn’t supposed to park. The
policeman asked him for the registra-
tion and license. So he pulled out
the registration I had in the glove
compartment and went into his
189
 An Adolescent Suicide
billfold for his license. It wasn’t
there. Luckily the policeman was
nice enough to accept his word. ‘‘I
have got a license; this is my
mother’s car.’’ He didn’t make any
fuss . . . We had a shake down all
over the place. We asked Tim, and
he didn’t have any idea where it was.
One of my younger sons said to me,
‘‘I bet I can tell you where it is.’’ I
said, ‘‘Where?’’ ‘‘Go under Tim’s
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mattress.’’ We went under it, and
there it was. He [Tim] had been
using it. He was a big good-looking
kid and had been using it for proof
to go into bars and get drinks. I
talked to him . . . Finally I turned
him loose. Before I had my back
turned on him, his brother went
right through the wall. There was a
hole in the sheet rock.
David: Was he ever violent toward you?
Jane: Oh yes. He chipped the bone in my
wrist one time. I can’t remember
what the situation was about. It must
have been fairly trivial or I would
remember. But it degenerated into a
battle of wills. I said, ‘‘You will.’’ He
said, ‘‘I won’t.’’ He wound up letting
my wrist have it. He was totally
devastated.
David: Was his father a violent person?
Jane: He could be.
David: When he punished the children,
did he beat them?
Jane: It depended on which child. He had
favorites, and Tim was an unfavorite.
My husband is a fantastically brilliant
person. Very brilliant and very crea-
tive. One thing where he was like
Tim is the mood swings. Terri¢c
mood swings. He was usually on top
of the world or down in the dumps.
David: You said Tim wasn’t one of his
favorites. Was Tim a special target?
Jane: Yes he was.
David: His father didn’t show the episodes
of violence that Tim showed?
190 VOLUME 8  NUMBER 2  2004
Jane: Not to that extent. With Tim you
didn’t know what triggered him o¡.
Just a few days before he died (I
didn’t learn this till much later) Tim
was working on Tina’s car. He was
doing something to it and he needed
a tool. He went over to my brother
to borrow it. So my brother was
helping him work on the car. Tim
said, apropos of absolutely nothing,
‘‘I can’t tell you how I despise
myself.’’ My brother said, ‘‘Why?’’
He said, ‘‘Because everybody for-
gives me. Everybody gives me
chance after chance, and I spit on
them. Mom, whenever I do some-
thing stupid, screams, yells, throws a
tantrum, bounces things o¡ the wall,
and then she pulls herself together
and gets me out of it. She helps me.
She’s only one. Dozens of people
have done it. And I spit on them,
and I don’t know why.’’ Then he
started to talk about cars. My
brother told me that quite some time
after Tim died. So apparently the
idea of suicide was germinating for
some time.
David: What was the e¡ect of his suicide
on the family? Did it have an e¡ect?
Jane: I don’t think it made any changes,
other than—this is going to sound
absolutely horrible. Horrible as we
all felt, much as we missed him and
the terri¢c load of guilt that we were
all under (in spite of the fact that we
realized intellectually that we weren’t
guilty; emotionally you will never
feel that you are not guilty), it was
almost a relief. For years, every time
the phone rang or I heard a siren, I
would lose my stomach. Ask not for
whom the bell tolls. I generally was
right. It was the police coming to
the house. Or the police were on the
phone. It took me a good year to
stop reacting like this to a police
siren or a telephone call. I remember

being out in a car just a few days
after he died and hearing a police
siren. After my initial reaction, I said
to myself, ‘‘All right. You’re safe
now. You’re safe.’’
We took him to a psychiatrist, and the
psychiatrist gave him tests (draw a person,
a house and so forth). Tim told me he took
to him right o¡. He was supposed to be
the best for adolescents in mucho miles
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around. He said he showed low self-image,
but didn’t show destructiveness or any-
thing. Of course, this was about three years
before he died. I’m very bad about time.
Three years, I guess, because it’s four years
this week that he died. He said a very low
self-image. He talked to him, and he
worked with him a little. He said to me,
‘‘You are going to have a fantastic man
here.’’ I said, ‘‘Am I? If I live.’’ He said if
we could just kind of bear with him. ‘‘You
are going to have a ¢ne man there,’’ he
said. ‘‘I really don’t think he needs counsel-
ing.’’ Then I took him for months and
months to the children’s psychiatric center
in Pomona, which is good. Then we had
counseling through the school. You might
as well as have saved your breath to cool
your porridge.
DISCUSSION
A Commentary by Christianne
Esposito-Smythers & Anthony Spirito
Our current knowledge base indicates
that the large majority of adolescents who
commit suicide had a preexisting psychia-
tric disorder. Tim likely met criteria for
comorbid bipolar disorder (BPD) and con-
duct disorder (CD). CD occurs in approxi-
mately 22% of children and 18% of
adolescents with BPD (Geller & Luby,
1997). Among youth with comorbid BPD
and CD, CD is equally likely to antedate or
ARCHIVES OF SUICIDE RESEARCH
C. Esposito-Smythers et al.
postdate the onset of the ¢rst bipolar
episode (Kovacs & Pollock, 1995). For
Tim, CD may have preceded the onset of
BPD. According to his mother’s report,
Tim evidenced his ¢rst symptoms of CD at
the age of 11 (adolescent onset). Tim initi-
ally presented with minor conduct pro-
blems in the home and school setting for
which he did not receive appropriate conse-
quences. These behaviors then quickly
escalated to severe conduct disordered
behaviors including physical ¢ghting, phy-
sical cruelty to others, ¢re setting, destruc-
tion of others property, breaking and
entering, lying, and stealing.
Tim’s family background is consistent
with that found in families with antisocial
youth. Many statements made by Tim’s
mother re£ect evidence of coercive
processes and poor parental monitoring
(Patterson, 1986). When the interviewer
asked whether Tim’s father ‘‘beat’’ or ‘‘hit’’
the children as a form of punishment, she
noted that ‘‘it depended on the child’’ and
described Tim as his ‘‘unfavorite’’ child.
She also noted that his father ‘‘put him
down verbally a lot,’’ suggesting verbal
abuse. She added, ‘‘If we would have been
living with his father at the time he died,
he and his father would have had it out
over the tables and chairs. I know it.’’ In
reference to her interactions with her son,
she referred to a few situations in which
they yelled and swore at one another which
she referred to as a ‘‘battle of wills.’’ One
of these battles escalated to physical aggres-
sion (i.e., Tim chipped the bone in her
wrist). These interactions typically ended
with Tim’s mother’s withdrawal. In addi-
tion, there was clear evidence that Tim was
neither properly monitored nor disciplined
for his coercive or delinquent behaviors.
Tim apparently spent much of his time
with a deviant peer group with whom he
engaged in multiple delinquent acts.
Tim’s coercive behaviors and delin-
quent acts likely increased in severity and
frequency with the onset of BPD. Youth
191
 An Adolescent Suicide
with comorbid CD and BPD are character-
ized by particularly poor judgment and
grandiosity. There is evidence through-
out this transcript to suggest that Tim
experienced recurrent hypomanic episodes
and thus would likely have met criteria for
BPD NOS. Hypomanic episodes are char-
acterized by abnormally and persistently
elevated, expansive, or irritable mood in
combination with three (four if the mood
is predominantly irritable) or more of the
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following symptoms: decreased need for
sleep, pressured speech, racing thoughts/
£ight of ideas, increased motor activity/
goal directed behavior, involvement in
pleasurable activities with a high degree of
danger, in£ated self-esteem/grandiosity,
and distractibility. These episodes are not
severe enough to warrant hospitalization
and do not include psychotic features, but
are associated with a marked change in
functioning that is directly observable by
others.
Consistent with hypomania, Tim’s
mother reported that Tim repeatedly dis-
played an abnormally irritable mood. He
exhibited ‘‘immense mood swings’’ and
became violent even in the absence of pro-
vocation. This presentation is consistent
with that found in the literature. Irritability
among youth with BPD can become
rapidly violent resulting in assaultive,
destructive, and extremely aggressive beha-
vior (Wozniac, Biederman, Kiely, et al.,
1995). This irritable and unstable mood
often leads to con£ictual relationships with
parents and siblings, as was evident in
Tim’s family. Second, Tim reportedly
exhibited goal-directed behaviors. For
example, Tim’s mother reported that he
‘‘passed the 12th grade in three months’’
and frequently described his wood working
and gardening as ‘‘beautiful when he was
in the mood.’’ Third, Tim engaged in a
number of pleasurable activities with a
high level of danger. In youth, this symp-
tom commonly manifests itself in impul-
sive risk-taking behaviors. Tim’s mother
192 VOLUME 8  NUMBER 2  2004
described multiple episodes of wild driv-
ing, burglary, and vandalism. Fourth, these
risk-taking behaviors were likely driven by
in£ated self-esteem. In youth with BPD, it
is not uncommon for them to steal items
yet appear impervious to police and parents
who attempt to make them see that stealing
is wrong and illegal. They perceive stealing
as wrong for others but not for them
because they are ‘‘above the law’’ (Geller
& Luby, 1997). This aspect of Tim’s pro-
blem was evident in the interaction he had
with his mother after stealing a wood
working tool. When she asked him why he
stole the tool he merely replied, ‘‘I thought
that you could use it.’’ This connection
between Tim’s in£ated self-esteem and
delinquent behavior might also explain the
high frequency of his antisocial acts and the
fact that he ‘‘got caught all the time.’’ Tim
may have been attempting to show others
the scope and superiority of his delinquent
abilities. For example, Tim’s mother
described an incident where he broke into a
home and left behind a knife with his initi-
als on it, neglecting to take anything from
the home. Tim may have exhibited addi-
tional hypomanic symptoms, but insu⁄-
cient information was available in the
transcript to comment on them.
One of the strongest risk factors for
child and adolescent onset BPD is a family
history of BPD (Benton, Weller & Weller,
2000). There is also evidence in the tran-
script to suggest that Tim’s father may
have had BPD. Tim’s mother stated that
he had ‘‘terri¢c mood swings’’ and was
usually ‘‘on top of the world’’ or ‘‘down in
the dumps.’’ She also described episodes
of goal-directed behavior noting, ‘‘There
was this project and then there was that
project—everyone was expected to fall in
with the enthusiasms and drop them when
he did.’’
Sha¡er and Pfe¡er (2001) o¡er a clini-
cal model to explain the onset of suicidal
behavior among youth which begins with
the onset of a psychiatric disorder and

incorporates many of the risk factors
evident in Tim’s environment. According
to this model, adolescents with an active
psychiatric disorder, such as a mood disor-
der, experience suicidal ideation as part of
the disorder. Alternatively, a stressful event
(e.g., family con£ict), often caused in part
by the underlying psychiatric disorder, may
trigger an acute mood change (e.g., hope-
lessness, dread) which in turn, triggers
suicidal ideation. Once suicidal ideation is
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experienced, the presence of various envir-
onmental factors either ‘‘inhibit’’ or ‘‘facili-
tate’’ whether an adolescent acts on his/her
suicidal thoughts. Factors that inhibit suici-
dal behavior include certain social variables
(e.g., available support, presence of others,
di⁄cult access to suicide methods) as well
as a particularly low level of mental agita-
tion. Factors that facilitate suicidal beha-
vior include underlying personality traits
(e.g., impulsivity), certain social variables
(e.g., being alone, available suicide
method), and an agitated mental state.
Tim exhibited symptoms consistent
with diagnoses of BPD NOS and CD.
Both mood and conduct disorders have
been shown to increase the risk of suicidal-
ity among adolescents (Brent, Perper,
Moritz, et al., 1993; Lewinsohn, Rohde, &
Seeley, 1996). There is also evidence to
suggest that Tim experienced suicidal
ideation. For example, Tim reportedly told
some of his friends and his older brother
that he had considered suicide. Comments
made to his friends suggested that he
believed, ‘‘It was the ultimate answer. If
things got where he absolutely couldn’t
handle them he’d get out of it. It was the
ultimate running away because nobody
could bring you back.’’ His suicidal
ideation may have been experienced as part
of his mood disorder and/or triggered by
stressful events and corresponding mood
changes.
Just prior to Tim’s suicide, his mother
reported the occurrence of a few stressful
events. First, Tim and his peers vandalized
ARCHIVES OF SUICIDE RESEARCH
C. Esposito-Smythers et al.
his father’s house. Second, when he
returned home, he realized that he missed
his mother’s birthday. It is possible that
these events triggered an acute mood
change. He may have experienced dread
over having to face his father after causing
irreparable damage to his father’s property.
In addition, he may have felt hopeless
regarding his ability to control his mood
swings and related assaultive/destructive
behavior, as well as guilt over missing his
mother’s birthday. This mood change may
then have led to the onset of serious sui-
cidal ideation. Once the suicidal ideation
arose, Tim made a conscious e¡ort to sepa-
rate himself from others and did not share
his thoughts/feelings which might have
reduced his apparent mental agitation. He
also had availability and familiarity with a
suicide method—his foster sister’s car.
According to Sha¡er and Pfe¡er’s model
(2001), under such conditions, a suicide
attempt was likely.
The treatment that Tim received in the
community is not atypical for adolescents
with his level of psychopathology in that
he was seen by several mental health
professionals for short periods of time
without marked improvement. Given the
complexity of Tim’s diagnostic picture and
environmental surroundings, he likely
required a multi-modal treatment approach
for suicide prevention e¡orts to be success-
ful. Treatment would most likely include
pharmacotherapy targeted at reducing the
number and severity of Tim’s mood
swings. Mood stabilizers currently used for
this purpose include lithium, valproate,
and carbamazepine. To date, results of
open and controlled clinical trials suggest
that lithium may be most e⁄cacious in the
treatment of child and adolescent BPD
(Benton, Weller, & Weller, 2000), although
valproate is often used in clinical practice.
In addition to pharmacotherapy, a combi-
nation of individual, family, school, and
community interventions would likely be
indicated. Individual treatment might focus
193
 An Adolescent Suicide
on training in problem-solving, emotion
regulation, impulse control, and anger
management, in an e¡ort to remediate
skills de¢cits that underlie self-destructive
behavior (Rudd, Joiner, Jobes, et al.,
1999). Family treatment might include
psychoeducation about BPD and CD, as
well as parent-management training. Par-
ent-management training has been shown
to e¡ectively reduce conduct problems
among children and adolescents (Brestan
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& Eyberg, 1998). Given Tim’s di⁄culties
in the school setting, a psychoeducational/
neuropsychological evaluation would have
been warranted. Based on the results, Tim
may have quali¢ed for Special Education
services to address his academic and beha-
vior problems. Finally, a community inter-
vention might focus on decreasing Tim’s
deviant peer relationships and increasing
his prosocial peer a⁄liations and commu-
nity involvement. If Tim and his family
members were unable to follow treatment
plans, then residential treatment might
have been necessary to address e¡ectively
Tim’s behaviors and prevent his suicide.
A Commentary by David A. Jobes
It is tragic to say, but nevertheless true,
that what is remarkable about the case of
Tim is how unremarkable his story actually
is. Each year throughout the world thou-
sands of teenagers like Tim prematurely
end their lives. Tim’s mother Jane, like so
many other survivor-parents, struggles to
make sense of something that seems utterly
senseless. By his own hand, her baby boy/
man is gone before his time. How can any
mother, any parent, ever reconcile such a
wretched reality? Frankly, under such grim
circumstances, maybe the best one can do
is to try to make a di¡erence in an
unknown life that may yet hang in the bal-
ance. This is why Jane is telling Tim’s
story, her story, to try to make a di¡erence
194 VOLUME 8  NUMBER 2  2004
to some other young person just like Tim
and some other mother just like her.
Tim was a troubled, depressed, con-
duct-disordered young man, like so many
other teenage suicide completers (Berman
& Jobes, 1991). Like the vast majority of
teens who kill themselves, Tim revealed his
preoccupations with suicide to trusted
others (his friends and uncle). Tim’s pro-
pensity for vandalizing, stealing, and set-
ting ¢res speaks to a history of
destructiveness that was ultimately turned
on himself. Of course, as Jane forthrightly
describes, this destructive, lying, violent,
acting-out child does not adequately
describe the totality of her child. She
describes quite convincingly that Tim was
also a sweet, thoughtful, and loving son
and sibling. But Tim’s ‘‘super sweet’’ side
was oftentimes profoundly eclipsed by the
sheer magnitude of his conduct-based
behaviors and problems. By his mother’s
account, Tim would ‘‘look you right in the
eye and lie,’’ he would steal ‘‘anything,’’ he
was often violent, and he had ‘‘immense’’
mood swings. When asked to account for
his behaviors, Tim would have no explana-
tion whatsoever, indicating that he simply
did not know why he did what he did. As
is often the case with troubled children
growing into their adolescence, Tim found
himself befriending likeminded troubled
peers whom Jane describes as ‘‘odd’’ and
‘‘spooky.’’
While Tim’s history is germane to his
demise, a particularly crucial element to his
suicide is the degree of self-loathing that he
seemed to have. The conversation with his
uncle reveals a deep sense of how much
Tim despised himself. He further revealed
how inexorably compelled he was to get in
trouble, always disappointing those who
desperately wanted to believe in him and
give him a second, third, and fourth
chance. The forces that compelled Tim to
engage in his troubled behaviors are quite
complex; he plainly was out of control and
seemed to have no conscious will or ability

to restrain his behavior. It is almost as if
any e¡ort to do or be better was inevitably
undone by a tide of misconduct that always
seemed to pull him under. As described
elsewhere (Jobes & Karmel, 1996) from
a psychodynamic perspective, there are
complex theoretical ways of describing
how children come to hate themselves so,
¢nding themselves unconsciously com-
pelled to con¢rm, through behaviors, deep-
ly felt perceptions of self. In the case of
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Tim it seems plain that he saw himself as a
‘‘screw-up,’’ unable to stop himself from
doing ‘‘something stupid.’’ The psychody-
namic loop here is critical. Tim saw himself
as a screw-up which led to his behaviors;
his behaviors, in turn, further con¢rmed
that he was in fact a screw-up. The idiosyn-
cratic and particular ways these dynamics
take root can be puzzling. Tim was clearly
a troubled youth in a less than perfect
family. Yet, many kids have troubles, and
no family is perfect, but the vast majority
of these kids will not take their lives as did
Tim. For parents and professionals alike,
how such forces uniquely prey on certain
youth leading them ultimately down the
path to a suicidal death is often madden-
ingly di⁄cult to understand and sometimes
even mysterious.
Another key construct contributing to
Tim’s tragic death is a notion discussed by
Joiner, Pettit, Walker, et al., (2002) in
terms of perceived burdensomeness.
Clearly Tim perceived that he had become
a huge liability to those who loved him.
He expressed abject helplessness as to his
ability to stop his misconduct; it was
beyond him, and it was hurting those who
loved him. It is almost as if he resented
being helped or given a second chance. His
uncle quotes Tim as saying, ‘‘ . . . I spit on
them [those who help], and I don’t know
why.’’ Completely forgetting his mother’s
birthday was certainly a straw among his
last straws—yet another screw-up, an
unthinkable slight to his mom, that was
obviously di⁄cult to bear.
ARCHIVES OF SUICIDE RESEARCH
C. Esposito-Smythers et al.
The other particularly tragic aspect of
this case worthy of note is the abject failure
of the clinical care that Tim encountered.
As described by Jane, Tim was remarkably
open to receiving care. His receptivity was
highly unusual for a conduct-disordered
teenage boy. It seems from her description
that there was a considerable under-
response on the part of the psychiatrist and
other mental health contacts. If indeed his
sense of negative self-regard was as deep as
it seems, then a great deal of intensive psy-
chotherapy would have been needed to
give him even a ¢ghting chance. It is
remarkable to note that Tim was actually
paying for the psychotherapy himself! But
it ended uneventfully when both he and his
mother concluded that it was not helping.
With the bene¢t of 20:20 hindsight, it is
always easy to Monday-morning quarter-
back the work of another clinician, which
can often be unfair. However, it is hard to
imagine given the profound pervasiveness
of his conduct problems and his apparent
degree of self-hate that his mental health
provider would come to the conclusion
that Tim no longer needed regular weekly
psychotherapy.
Finally, something must be said of
Tim’s mother, Jane. While Jane’s tragic
story may not be that unusual, her parti-
cular experience as a suicide survivor and
her willingness to talk so frankly and forth-
rightly is notable (Jobes, Luoma, Hustead,
et al., 2000). Throughout the interview
Jane never blames others, and she never
makes excuses for her son. It is also inter-
esting to note that Jane does not feel stig-
matized by others due to her son’s suicide.
This is clearly an extraordinarily candid
and compelling interview of one surviving
mother’s personal tale. Remarkably, Jane
even admits, while horrible to say and with
feelings of guilt, that Tim’s death ‘‘ . . . was
almost a relief.’’ This comment should
neither be taken out of context nor con-
strued as crass or unloving. As Jane hon-
estly describes, living with a troubled child
195
 An Adolescent Suicide
like Tim is a kind of family hell. Never
knowing when the next arrest might occur
and who might be inadvertently hurt is a
profound stressor on any family system.
But to be sure, Jane loved her boy and
would bring him back in a moment if she
could. Therein lies the tragedy and with it
perhaps the only glimmer of any good that
may come from Tim’s story. Suicide invari-
ably brings a most cruel reality to our
attention, that no matter how much we
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love, help, treat, or care, none of us can
ever completely control the destiny or
demise of another (Berman, Jacobs, &
Jobes, 1993). It is often the case that the
best we can do is the best we can do. In the
case of Tim, I think Jane did her level best
to do what she could think of to do, and it
still did not save his life. In the aftermath
of her personal tragedy Jane seeks a simple
outcome—to somehow help others to do
better so that they may make a life-saving
di¡erence. As noted towards the end of the
interview, Jane obviously hopes to help
others—suicidal youth and their parents—
through a metaphorical organ transplant
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196 VOLUME 8  NUMBER 2  2004
(i.e., a candid interview telling Tim’s story
as honestly as she possibly can). If the story
of Tim’s life and death makes a di¡erence
for one child or one family, then in some
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AUTHOR NOTE
A complete 17-page, single-spaced tran-
script of the interview can be obtained by
writing to David Lester, Ph.D., Center for
the Study of Suicide, RR41, 5 Stonegate
Court, Blackwood, NJ 08012-5356, USA.
Please include US$3 to cover copying and
postage.
Christianne Esposito, Brown Medical
School (Christianne Esposito@brown.edu)
David Jobes, Associate Professor of
Psychology, Catholic University (Jobes@
cua.edu)
David Lester, Director of the Center
for the Study of Suicide, Blackwood, NJ
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Anthony Spirito, Professor of Psychia-
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