Death Wish

Death wish, n.
1. Psychiatry

• A desire for self-destruction, often accompanied by feelings of depression, hopelessness, and self-reproach.


• The desire, often unconscious, for the death of another person, such as a parent, toward whom one has unconscious hostility.

2. A suicidal urge thought to drive certain people to put themselves consistently into dangerous situations.

Bear is not what I consider to be suicidal. He definitely doesn't have a plan, and if you ask him, he won't even admit to suicidal impulses, but something that became painfully clear at therapy on Saturday when we were discussing how unsafe it was to go wandering alone, at night, in the rain, and worst of all GETTING IN A CAR WITH A TOTAL STRANGER, was that Bear not only thinks he's invulnerable, but he also doesn't care if anything happens to him. He frequently takes unnecessary risks, as though he has a "death wish" or is passive aggressively suicidal. In other words, I don't think he will attempt suicide, but he certainly puts himself in situations where death is possible. He won't deliberately step out into traffic, but he won't look both ways when crossing the street.

When Bear first moved in with us 4 years ago, he definitely had a strong death wish. We were convinced that he would be dead by 18, as that seemed to be his goal. He wanted to be front line Marines where the likelihood of death was huge, and he was OK with that. His other life goal was to be in a gang dealing drugs. He really didn't seem to care which. {OK, he did have one other life goal. He also wanted to be a professional football player, but he found out within a few months of arriving in our home, that he was done growing (at not quite 5'9" that pretty much negated a pro football career).}

After residential treatment, diagnoses and the right medication cocktail, we saw a lot of improvement, but as I look back I realize that Bear's ambivalence about dying, never really went away. His self-destructive behavior isn't as severe (no more cutting, yea!), but what I've been seeing as lack of impulse control and poor judgment, I'm now seeing as potentially being related to this. Some events can be explained by lack of coordination and difficulty understanding of the consequences of his behaviors, but his recently stated lack of caring if something bad happens to him really explains a lot.

In therapy while we were talking about risky behavior, Bear suddenly brought up a teenager who he claims drives like a maniac in our neighborhood and implied if Bear stepped in front of the car, it would be the teenager's fault and he "should know better than to drive like that." Bear clearly stated that he didn't care what happened to him, and was acting kind of macho about it. It was a little about the teenager learning a lesson and a lot about letting us know that he didn't care if he got hurt.

Now we're discussing consequences for that weekend's events and I don't know what to do. Some consequences were obvious.

• No longer allowed to isolate and sleep on the porch at Grandma's house.


• Grandma is in charge of meds for the weekend - if he'd had to take meds from Grandma she would have known he wasn't in the house at bedtime (9pm, although we don't make them sleep at that time, just be in their rooms), instead of coming in at 10:30pm.


• Not allowed to leave the property without an adult.


• Doubling his sleeping med (he claims that 2 makes him groggy the next day, but from what the school has said, that's bull and anyway he can be a little tired in Sunday School without it being a big deal).

Consequences at home is more difficult. Normally FAIR Club assignments are designed not to punish, but to help the child learn a lesson. Bear definitely needs to learn that there are consequences to his actions, but most importantly he needs to understand why what he did was wrong, and quite frankly, I can't think of how to teach that.

Normally when a child displays risky behavior, then I try to show them the potential consequences of that behavior, but in this case, the potential consequences are death, rape, and serious injury, and not only does Bear not believe this will happen to him, but he doesn't totally care if he gets hurt or killed. So what the heck do I give him for consequences?

I did some online research, thinking maybe his assignment could be a research paper, but the statistics show that it's mostly women and young children being raped and murdered, which Bear would just see as proof that his behavior was fine for him (because he's not female or a child). The problem is that I can't show him that the 5% that happens to adult males, is 90% more likely to happen to him than to the average adult male because he is actively taking serious risks. And even if I could, that doesn't change the fact that he doesn't care.

I've contacted his case manager (who passes information on to his psychiatrist), and his next appointment is only 4 days away. Since he's not exactly suicidal I'm OK with this, but when the case manager asked me what I thought should be next steps, I didn't have an answer. If he were actively suicidal then our next steps would be obvious. If this were a recent or changed behavior then our next steps would be a little clearer. I know this behavior is a little worse (or maybe we're just noticing it more) because he's depressed. I'm sure the psychiatrist will be increasing his anti-depressant and/or mood stabilizer. But for something this pervasive and ongoing is this part of his identity or issues that can only be addressed with extensive therapy?

In the meantime, what do I do for a FAIR Club assignment? It doesn't have to be the perfect logical consequence that teaches the lesson in such a way that Bear gets it and changes forever (although if anyone has one that would be great!), but it does need to at least be related to what happened so he understands that his actions have consequences. It also needs to be concrete and immediate. Bear has absolutely no idea why this type of behavior would lead to us not wanting to put him behind the wheel of a car. He just doesn't seem to get the connection.

Suggestions?