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Teen attempts suicide after being kicked out of a Whatsapp group he started. More broadly, teenage suicide rates have spiked around the world.

Unbelievable. Surely, teens today are soft and silly? But what if I told you there is nothing surprising about this?

A teacher friend recently shared with me a case he had to attend to. A teen had been kicked out of a WhatsApp group he had started. Although he was gloomy for a few days, it still came as a massive shock to his parents when they found him attempting suicide with pills a few days later. They didn't know it bothered him that much. 
 

Inevitably, most folks would have formulated an opinion on this by now. Perhaps it is shock - how can such a trivial matter snowball to almost a life-ending tragedy.  Or perhaps condemnation, that kids today are too soft. Or judgement, that teenagers are just wildly emotional. 

More broadly, teenage suicide is an increasingly serious problem all around the world. According to the National Center for Health Statistics in the US here and here, suicide is the second-leading cause of death among adolescents and young adults aged 15-24. Results from the 2019 Youth Behavioral Risk Factor Surveillance System show that in 2018, 18.8% of high school students seriously considered attempting suicide and 8.9% attempted suicide.

When I am at, in Singapore, suicide is the leading cause of death for those aged 10-29. The number of suicides have been steadily rising; 2019 saw a record high for 10-29 suicides. 

So what's happening? Is it true that this generation has gotten softer. And has this led to higher rates of suicides?

Here is where we can see the value of neuroscience. If we take the time to objectively understand the teenage brain, we will see that there is nothing unexpected about this. 

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Almost everything with regards to teenage behaviour can be traced to 1 feature: 

||  In our teenage years, our brain is not fully developed. The most rational part of our brain, the frontal cortex, is only about half-formed. (You can see this in the top left corner of the picture above). What does the frontal cortex do? Rational thinking. Long-term strategy. Gratification postponement. Emotional regulation. These are more challenging for teens as their frontal cortex develops. 

 

Additionally, at this age, the emotional regions and neurochemical systems in our brains are already running at full steam. (In some instances, more active than they will ever be at any other point in life). 

 

When a teenager gets a bad grade for a test, the immediate emotional impulse is that they might think "I'm not smart, I'm not as good as everyone else." With the maturation of the frontal cortex, we are able to reappraise the situation to appreciate context - "It's not that I am dumb, but I did not study as hard as others" or "I need to change my study methods to have more practice and less theory." A mature frontal cortex has a higher chance to reframe the issue to be less absolute and more nuanced (as most issues are), taking into account variables and context, as something that can be changed rather than an innate, fixed condition.  


(Two small caveats: 1) rationality doesn't mean smarts; in our teens, we are eminently able to solve complex logic puzzles. Some of the best chess players emerge in their teens; 2) being driven by emotions are not necessarily a bad thing. In our older years, our rational regions might in-fact over-regulate, making us stick to what we are familiar with and be less creative).


A half-baked frontal cortex and a fully functioning (in fact, super-functioning) emotional and hormonal systems is the main explanation for everything unique about teenagers. It explains why teens are so creative and yet destructive, selfish and yet selfless, needy and yet impulsive, impossible to deal with at times and yet world-changing.

And, as we shall see below, it also explains why teenagers are much more sensitive to peer approval and social inclusion, to feel like they belong and are accepted. 

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Consider these 2 questions:

 

"What do you think others think of you?"
"What do you think of yourself?"

For most of us, the answers overlap, but only to some extent. There are major differences between how we see ourselves and how we think others see us. We know that there are parts of us that others simply don't see, don't understand, or misunderstand. Moreover, while we do take into account what others think, we don't necessarily agree with all of their views. 

 

This is corroborated by neuroimaging studies: when asked the 2 questions, 2 different circuits (involving the rational frontal cortex and the emotional limbic system) activate in the adult brain. The 2 circuits have some overlap - certain groups of neurons are activated in both. But there's also difference - certain neural networks are unique and activate for only one of the 2 questions. Exactly as we would expect. 

But what about teenagers? When asked the 2 questions, the circuits that activate in the brain are the same. Teens have tremendous sensitivity to what peers think of them. With a still-developing frontal cortex, our identity as teenagers is shaped a lot by the views of others.

Check out the 2 papers below for more information: Amanda Guyer et al at the National Institute of Mental Health; and Bregtje Gunther Moor et al from Universities of Amsterdam and Leiden

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So teenagers are especially bothered by what others think of them. What happens when they feel that others do not think much of them, when they feel snubbed or excluded?

 

Here we turn to the Cyberball paradigm, a simple yet effective experiment developed by Naomi Eisenberger of UCLA. Cyberball is an online game which involves 3 "players". They each have a character in the game which is simple enough - they would toss a virtual ball among themselves. The players get to pick whom to toss the ball to next. Ostensibly, there are 3 human players, but in reality, there is only 1 human - the participant; the other 2 players are a computer program run by the experimenter.

The participant is hooked up to a brain scanner so that his/her neural patterns can be observed. At first, the game takes place fairly normally. All 3 players are involved, and the ball is thrown to each player roughly the same number of times.

 

After a while, the experiment really starts -  the 2 players represented by the computer program stop passing the ball to the human player altogetherThe participant is made to feel excluded.

 

When we look at adult brain scans, 2 things happen:

1) Initially, there is activation of the Periaqueductal Gray, Amygdala, Insular Cortex, and Anterior Cingulate, - these are the regions that regulate pain, anger, disgust, and perception respectively. The participant is hurt by the exclusion.
 

2) But soon, the prefrontal cortex activates, and modulates the brain regions above. The more the prefrontal cortex activates, the less subjects are likely to be upset, and the more they would think: "Why get angry? It's just a game with strangers! It doesn't mean anything! I have my own group of friends. There is no reason for me to feel hurt."

 

The prefrontal cortex helps to make sense of the initial emotions by adding a layer of perspective, meaning, and regulation.

But as we should be familiar by now, the teenager has a half-baked prefrontal cortex. And their results are unsurprisingly different. 

 

A small number do show similar neuroimaging patterns, similar to adults. Initial activation of the areas of pain and anger, but then subsequently regulated by the activation of the prefrontal cortex. These are the teenagers who are least susceptible to rejection; they are able to cope.

But for the majority of teenagers, when social exclusion happens, even in such a trivial and seemingly meaningless game, the prefrontal cortex doesn't activate much. They feel terrible, hurt and upset that they have been excluded, cast aside in a game. Without the prefrontal cortex's perspective and rationalisation, they are unable to move away from the pain from the initial emotions. 

 

Read more about Eisenberger's research here:

 

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This is a good point to segue back to our original story - a teen booted out of his own WhatsApp chat reacts by attempting suicide. On top of this, teenage suicide rates worldwide has been increasing. 
 

We might judge teenagers to be overly sensitive or lacking resilience. 

 

But what does objective truth tell us? The teenage brain is different from the adult brain. All of us have a prefrontal cortex that is still developing when we are in our teens. The consequence is that teenagers are impulsive, take more risks, and are more emotional. Crucially, they weigh the opinions of others more. While all of us are social animals, teenagers particularly value social inclusion & peer acceptability - because how others think of them is how they see themselves. 

 

Conversely, what happens when teenagers feel excluded or think that others judge them poorly? With their stronger need to fit in, rejection hurts them more.  


These effects are biological. It is happening to the teenager without him/her really being aware of it. No teen walks around saying please don't judge me, I might act a bit different because my prefrontal cortex is still developing. But the impact is real. Would you judge a person who has a half leg for walking differently? Would you blame an older person for having a poorer memory? Or a person with post-traumatic stress disorder for being overly-anxious? If not, should we blame teenagers for being emotional?

 

One last question. If teenage brains have always been this way, why are suicide rates rising? Shouldn't teenage suicide rates always be high? We only need to look at the environment we are in compared to the past. With social media and group chat applications like WhatsApp, it's much easier for us to communicate with people all around the world. But this also means it's much easier for people to feel rejected or left out, when they are not part of all these groups which are visible to them. 

Social media also impacts how identities are shaped. Images and lives on social media are curated, appearing much better in comparison to our own lives. Someone overly affected by these comparisons feel that they lead lesser lives with a smaller identity. 

With a better understanding of how we really tick, we avoid subjective opinions and examine objective evidence - how can we help people in a manner that truly addresses their problems. 

It is only with a good understanding that we can understand what is it that really bother teenagers -to realise that the opinions of others weigh heavier on them. That exclusion hurts them more. That where we can most meaningfully  help them is in finding and building their identities, beyond what others think of them. And to help them find areas of interest and way of accountability where they can build their confidence and become more resilient. 


In an upcoming piece, we will discuss specific steps that we can take to help teenagers.

In the meantime, check out:

The extraordinary human brain

The interaction between logic and emotions

Dopamine, often quoted but almost always misunderstood
 

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