A glimpse into the world of childhood mental illness

The cut of mental illness can be  sharper than any surgeon’s knife. What happens when a child’s emotional turmoil escalates beyond a family’s control?  In the  newly released book Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service: What Happens to Children with Acute Mental Illness, Drs. Laura Prager and Abigail Donovan bring us behind the scenes of the Massachusetts General Hospital psychiatric emergency room. Although the discussion can be somewhat technical, the real-life stories are poignant and are fascinating not only for healthcare professionals, but for anyone interested in child mental health.

In this excerpt, a dialogue occurs between Dr. E, a child psychiatrist, and Tommy, a depressed fourth grader who has just tried to strangle himself:

“I hate myself. I want to die.” Tommy’s voice lacked any inflection.


“I’m bad. The world is bad. No one likes me. No one wants me as a friend.”

“No one?”

“I’m a loser. No one wants to be friends with a loser. They all hate me.”

“Why are you a loser?”

“I’m fat. I can’t do anything right. I got in to trouble at school.”

“What happened at school?”



“I wrote bad stuff.”

“Bad stuff?”

“This one kid farts all the time and I wrote ‘fart’ on his notebook.”

“Then what happened?”

“The teacher made me apologize.”

“That’s it?”

“My parents get mad when I do stuff like that.”

“Were they mad this time?”

“I don’t know. I always get in trouble. No one in my family likes me, either. They won’t care if I’m dead.”

…Tommy’s voice got just a bit louder. “After school, I was really mad. I went down to the playroom and I tried to strangle myself. I didn’t have any rope, so I used my scarf. I also thought about going upstairs and trying to jump out a window.”

Did you hurt yourself when you tied the scarf around your neck?”

“No, I couldn’t get it that tight.”

“Did you think that you could kill yourself that way?”

“If I pulled hard enough.”

“So what happened then?”

“My mother came downstairs and found me.”

“I guess it was lucky that your mother was keeping an eye on you. Do you know why she came down?”

“I don’t know. She took the scarf and called the doctor. Here’s the scarf.” Tommy pushed the sheet away from him. He was wearing maroon hospital PJ’s that were slightly too big for him. Around his neck hung a dirty grey-colored knit scarf that looked as if it might once have been another color, perhaps light blue. It had remnants of fringe hanging from each end. The scarf hung loosely, and the ends tumbled into his lap. As he spoke, Tommy absentmindedly started stroking the tattered fringe on one end.

Dr. E tried to regroup. How could the nurses have let this kid sit in a bay with a scarf around his neck when apparently he had just tried to strangle himself with that very scarf?

“Is this the same scarf?”

“Yes. I just told you that. I had it with me.”

“Is this scarf your security blanket? Do you sleep with it?” Dr. E hoped she didn’t sound quite as incredulous as she felt.

“Well, I don’t take it to school, usually. It usually stays on my bed during the day.” He paused before adding, “I had it with me today. It was in my backpack. It used to be light blue. I’ve had it for as long as I can remember. I think my father gave it to my mother but she didn’t like it.”

“You tried to strangle yourself with the scarf you have held on to forever?”

Tommy was silent.

Dr. E fell silent, too.

Reprinted with permission. Courtesy of Praeger Publishers/ABC-Clio, 2012. Available on Amazon.com

Naline Lai, MD and Julie Kardos, MD
©2012 Two Peds in a Pod®

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