The CDC recently published an alarming report demonstrating the rise of US suicides since 1999. It raises complicated questions about potential causes and, more importantly, what can be done to intervene?
Since 2010 I have worked as a psychiatrist on a high acuity unit. We specialize in the care of suicidal individuals who have used a variety of means with variable lethality and present with a mixture of shame, regret, guilt, and resolution – some towards life, others with intent to use a different method next time. After an attempt, at one end are those who will never re-attempt and at the other are those who won’t stop until they are successful. In the middle are the group who we hope to alter the odds in our favor. I’ve had several losses and each one stays with me.
Suicide is an interesting phenomenon in that it represents the ultimate freedom we have over our destiny. Armed with increasing amounts of knowledge we make great efforts to care for our bodies while at the same time engaging in activities we know are detrimental and self-sabotaging. We smoke knowing the dangers, we eat the wrong things, and we partake in risky ventures for thrills.
Our variegated lives accurately reflect the complexity of humanity. Taking one’s own life is the culmination of that control. There are parts of our country that are recognizing the importance of that control in the face of terminal illness. But when it comes to the throes of depression, a suicide wreaks havoc on anybody within reach. The recent high profile losses produced a marked ripple effect throughout our entire country.
Our connectivity is likely a contributing factor to the rise of suicides. We see them as they happen and efforts to cover them up whether in news accounts or obituaries are not successful. We’re a savvier populace and we know the look of a suicide by its description, by its smell.
Depression is inextricably linked to suicide. Alienation, isolation, despair, and hopelessness are the breeding ground for the thought that the only escape is through death. There were times when religion held more sway and that impacted one’s sense of meaning and provided a barrier to acting due to the threat of eternal damnation. We are not as religious as we once were.
Economics, gender, cultural factors, age, and family history all play a role. Medicine is closer to identifying genes that place individuals at greater risk and we are working on tests to help identify people at risk. Of course, risk doesn’t imply action; those with the gene might never attempt suicide, while someone without the gene in question might. Openness to treatment is another variable. Men are at higher risk for suicide. Does a man feel less manly if he reaches out for help?
One major change I’ve witnessed in the past few years has been the rising contribution from opiates. It is common for a heroin addict to admit that they’ve flirted with overdose, like Russian roulette with a needle, due to the overwhelming nature of addiction.
The suicide of a parent is known to increase the risk of their children. The child, prone to the same genetic issues, seeing that the parent couldn’t make it, views suicide as an out for themselves when overwhelmed. Perhaps our world of near instant awareness through social media and news outlets puts us in a similar predicament – we see high profile people tragically ending their own lives and we wonder what hope is there for us?
All we want, those of us who are left behind, is a chance to go back and tell our loved one, our lost one, you matter. Don’t leave me. I’ll stay with you at all costs. Whatever you’re facing, we’ll do it together.
And that leads me to what we can do. Suicide, once done, cannot be undone. We in the mental health care world do a poor job predicting who will kill themselves. There are just too many variables with human behavior. But here’s what we know.
Depression leaves many traces including withdrawal from life, sadness, changes in habit, morose and hopeless content of speech. For some, addiction is the window through which we observe the struggle. When we see worrisome signs, we must act. We have to connect that person to helpful resources. That doesn’t necessarily mean pills and hospitals – it can mean family, community, church, a support group, or just one friend. Too many times we’re left to kick ourselves, knowing that we saw something that justified action, but we weren’t completely sure and didn’t want to be wrong. We didn’t want to invade someone’s personal space and risk being rude.
My advice: act on your gut instinct. If you think someone is struggling, they are. If your intuition is sending you an alarm, honor it and intervene. Gather all the people you know who care for that person and act as a group. Let the person know you’re there, there are resources. Keep your involvement high. It is far better to be wrong about your intervention than to lament not having done something. But you’re not wrong. Your gut is right. Act. You won’t regret it.
1-800-273-TALK – National Suicide Prevention Hotline