: How do I help an 11-year-old who says "I want to die"? I have an eleven-year-old daughter that I'm very worried about. She's a smart, passionate kid, and tends to have very dramatic moods. Over the years, she has occasionally

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How do I help an 11-year-old who says "I want to die"?
I have an eleven-year-old daughter that I'm very worried about. She's a smart, passionate kid, and tends to have very dramatic moods. Over the years, she has occasionally said "I want to die" when she's very upset, but always in passing.

Recently, she's been saying it a lot. I want to tell myself that this is just attention-seeking, but I also know that suicide is a major, real cause of death at this age range and I don't want to put my head in the sand.

From an objective standpoint, I think her life is pretty good. She doesn't have a lot of friends, but she does have a handful that she's close with — and they're all good kids. She doesn't want for much; she has her own computer and my wife recently gave her a hand-me-down iPhone — no service, but there's wifi at home and pretty much everywhere we go. And I think we have a pretty close relationship; she's starting to do some of the teenage go-to-her-room-close-the-door thing, but in general, we talk and she tells me stuff and I feel like we mostly "get" each other. She's not always sad; in fact, she's often excited, happy, and positive. But when she is sad, she seems deeply sad.

I know life can be hard as a middle-schooler, too. There are a couple of teachers she really hates, and she seems to spend more time than necessary stressing out about them — I mean, sure, not all teachers are great, but it's not like that's forever. I'm sure there's middle-school social stuff which seems insignificant from a grown-up perspective but big when you're down in it. She's got more homework than she'd like. We live in the city, and she has to share a bedroom with her two-years-younger sister. She's gone to a martial arts class basically her whole life (and is quite good at it, with natural talent), and we won't let her quit (it's good for her physically, and the lessons about respect and mental control are excellent) — but we let her quit violin, soccer, piano, history club, a whole list of things.

Sometimes, she gets into fights with her mother, who feels like she really doesn't listen when asked to do things like clean up her room. I'm a little bit more relaxed in general when it comes to such things, so I end up being the "good cop" (but sometimes putting me in a little bit of conflict with my wife, too). Last night, our daughter was picking on her sister; she called her a name (and it was bedtime and younger daughter was feeling on edge and burst into tears). My wife responded by saying that we don't tolerate bullying and took away her phone for the rest of the evening. This precipitated a very dramatic outburst — daughter claimed that she didn't mean it that way and that she was "sorry we heard it wrong" (but I agree with my wife that this is probably just avoiding responsibility).

So, we stood firm on the "no phone tonight" punishment (which is hardly harsh; we even pointed out that she could use her computer for an hour and go to bed). That caused a lot of yelling and tears and curling up on the floor shouting "I want to die", followed by going to her room and slamming the door and sobbing loudly. Little sister came out crying begging us to give big sister the phone back ("I just want her to be happy" — oh, this breaks my heart!) I went in and talked to her and said that we were serious and that she needs to treat her sister better, and she said she wants to jump out the window (which I recognize as a specific threat rather than just vague "I want to die").

She shouted at me to go away and leave her alone, so I said okay, and eventually, she calmed down and I brought her some applesauce and she went to bed relatively easily. But, we discovered later that she'd spent that intervening time instant-messaging with a friend, saying she wants to die (and the friend was messaging back "no, no, don't do it!"). This is a disturbing dynamic all in its own that might be a whole separate question... when we gave her the phone (and computer), we told her that we needed to know what she was doing and that her conversations weren't private, but we haven't really actively snooped. I feel like now we have to — but on the other hand, if we go into "internet lockdown", that's going to be another point of conflict and control issues, and while dumping stuff on a friend her age is kinda awful, she also communicates regularly with my parents (who are great) and a friend of ours who is a social worker, and I want her to feel like she can use that channel for real support. (I guess if I didn't think the internet could be helpful, I wouldn't be writing all this here!)

A few years ago, she was having a harder time, with really no good friends. At that point, we tried to get her into therapy, but that became yet another thing that she hated. It was a struggle to get her to appointments, and we didn't click with the first few therapists, and then even when we found someone we liked, my daughter didn't respond well and wouldn't meaningfully participate. So, that felt like a very expensive way to do nothing; I know therapy can be powerful, but, you have to put something in, and she was actively resisting.

Overall, I think there's a theme of control; she's always wanted to eat only sugar and simple low-nutrition foods, and it definitely became a point of conflict. In consultation with one of the therapists, we backed off of fighting over that; yeah, she has to eat healthily to live, but we didn't want to create an eating disorder. So, we offer healthier options and trust that she'll eventually make decent choices. Overall, she generally eats — well, not the worst; mac & cheese, pb & j, cheese pizza, etc., with the occasional broccoli and red pepper. This is a little hard on my wife, who cooks and would just like her to eat well, and sometimes they do still have strife over it.

I'm worried that if we threaten therapy, or, you know, actually force her to go, she'll see it as yet another awful thing where she has no control over her life and we're making her do, rather than actually being a support resource.

I know that medication is an option, but, honestly, I'm very skeptical. I don't mean this from a health-food sunlight-and-nature chemicals-are-scary point of view; see instead this Scientific American article and the research it talks about — overall, antidepressants appear to be only marginally better than placebos, and that margin may be due to publication bias or, as the article discusses, simply because the placebos don't have noticeable side-effects. And they do have side effects, many of them serious in their own right. I don't want to have a debate about drugs; I just want something that will really help, long term and significantly.

So, I don't know what you all can offer here; it was cathartic to type it all out. I'm going to talk to some professionals, but I also appreciate any anonymous peer support you can provide.

As stated above, I need something that will be a significant, long-term help. How can I help my daughter deal with or treat these suicidal thoughts?

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