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Why suicide? Trying to make sense of an unexpected death when there are no answers

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How are we to comprehend an act of self-annihilation by a member of our community, someone we may have known as talented, good-hearted human being? Mirror.co.uk
Tom Ellis of Menninger Clinic head shot column mug June 2014

“People kill themselves because they can’t help it.”

I have been studying and writing about suicide since the Reagan years; and, believe it or not, this simple statement, from a renowned, wizened suicidologist, comes about as close as I can get to a satisfying answer to the question “Why?” in the wake of a suicide. (The Houston arts scene was rocked last week by the death of a promising young writer, one of three apparent suicides in the past week in the city's art scene, according to a Free Press Houston columnist.)

I know, it’s not very satisfying.

How are we to comprehend an act of self-annihilation by a member of our community, someone we may have known as talented, good-hearted human being?

Explanations

Science tells us a lot about the vulnerabilities that set the stage for suicide – mental illnesses such as depression and substance abuse, social forces such as unemployment and gun availability, neurobiological factors such as serotonin and sleep deprivation. Yet, when it happens to someone we know and care about, knowing “the facts” falls miserably short for some reason.

 When the media portrays a suicide as “out of the blue,” bewildering and mysterious, you should know there’s much more to the story than has been told.  

It’s also true that the media tell us a great deal about suicide – much of which is unhelpful if not downright wrong. When the media portrays a suicide as “out of the blue,” bewildering and mysterious, you should know there’s much more to the story than has been told. Ironically, the same is true to the extent that the story presents a tidy and satisfying explanation: Once again, you can bet there’s more to the story.

It is simply unreasonable to presume to know the full story, much less convey it in 1,000 (or 10,000) words. Indeed, therapists who lose a patient to suicide, sometimes after years of therapeutic work, will tell you that even they don’t presume to understand why this patient, at this time, in this situation, followed through on his or her impulse to self-destruction.

Sometimes people attempt to explain things simply by labeling them. A favorite label for suicide is “selfish.” Compassionate observers are quick to object to this label, but to do so is to miss an important point. Of course suicide is selfish. But what’s important to recognize is this: The fact that a good and loving person can do such a “selfish” thing – an unspeakably hurtful act to those who love them – speaks to the unbearable anguish and cognitive impairment that occurs when one is in “suicide mode.”

In this state, a blinding force as intense as the survival instinct is turned on its head in an urgent desperation to end life, as the only apparent pathway to relief. Imagine your beloved, loyal pet savagely biting you because you accidently pressed on its recent surgery site. The frontal lobes of the brain, where we imagine how others feel and anticipate the consequences of our actions, are rendered irrelevant, while the survival brain, where emotion and action tendencies reside, take over to attend to more urgent – life-and-death – priorities.

Is there hope?

Actually, there’s more hope than space available here to share. The last two decades have seen major advances in understanding contributors to suicide, together with the development of psychotherapeutic interventions specifically targeting vulnerabilities to suicide. But such discoveries are useless unless people seek help, and more than half of people who kill themselves do not get the help they need.

 But such discoveries are useless unless people seek help, and more than half of people who kill themselves do not get the help they need. 

Getting the word out is not easy, but we’re doing better. Witness a recent movement by suicide attempt survivors, whose achievements to-date include getting the American Association of Suicidology to create a new division specifically for them. Their purpose is not to advocate for suicide – far from it. Rather, it is to provide a forum for telling their stories of survival and recovery to others who are still struggling to believe that a life worth living is attainable for them.

However many hopeful signs there may be in the field, there’s never been a public health problem solved exclusively by professionals; such problems are simply too widespread (nearly 40,000 suicides per year in the U.S. alone). Complicated problems can be ameliorated through amazingly simple measures: Fewer people die of heart disease, not only because of advances in surgical techniques, but also because fewer people are smoking. Fewer people die of AIDS, not only because of new drug therapies, but also because more people are practicing safe sex.

If you or someone you care about is at-risk, nothing can be more relevant than the simple advice to stay connected. Isolation and alienation from others make it, if not easy, then at least less difficult to take that final exit. Nothing is more tortuous than intense suffering combined with aloneness. We know from a mountain of research that social support enhances health and life, both quality and quantity. Feeling a sense of connection (read: caring) from only one other individual can make the suicide option, not only less imaginable, but even irrelevant.

How You Can Foster That Connection

Reach out, whether it is you who are struggling or you who notice someone else is in pain. “Are you OK?” is a caring question with potentially life-saving value. “Help is available” is the most important information to share. And, if reaching out doesn’t work, then call the National Suicide Prevention Lifeline: (800) 273-TALK. They will give you the space to talk it over and even refer you to someone local to follow-up with. It’s free, and you’ll never make a better investment.

People do kill themselves because “they can’t help it;” but a helping hand can be all it takes to lift a suffering soul out helplessness, and open doors once thought hopelessly closed.

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What to Do If You’re Concerned

The following are things you can do to help prevent a suicide. Further details can be found at visit www.suicidology.org and www.afsp.org.

• First and foremost, don’t assume that suicide can’t happen. People who kill themselves often do their best to “keep up appearances” and “not trouble anyone.”
Recognize warning signs. These include social withdrawal, increased drug and alcohol use, insomnia, risk-taking, preoccupation with death and other uncharacteristic behaviors.
Don’t be afraid to ask, “Are you OK?” The more concerned you are, the more you need to ask directly, “Are you thinking about suicide?” Don’t worry, you won’t put thoughts there that aren’t already present.
Don’t use “reverse psychology.” Confrontations like, “Go ahead, see if I care” are risky and likely only to drive your loved one further away.
Do what you can to make the environment safe. At the top of list are firearms, which rarely allow second chances.
Remember that alcohol and drugs significantly increase suicide risk. Encourage sobriety, while seeking other ways of feeling better.
Involve caring others, if possible. Keeping secrets is dangerous and places too much responsibility on your shoulders.
Encourage the use of crisis lines, such as the National Suicide Prevention Lifeline: (800) 273-TALK or Crisis Intervention of Houston Hotline at 713-HOTLINE or 713-529-TEEN or 713-526-8088 (in Spanish),
Recognize when the situation has become an emergency and call 911. If your loved one is out of control, threatening suicide, intoxicated, refusing efforts to help and/or has access to lethal means, urgent professional intervention is needed.

Dr. Tom Ellis is director of psychology and primary investigator of the suicide research program at The Menninger Clinic and professor in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine. He is co-author with Dr. Cory Newman of Choosing to Live: How to Defeat Suicide with Cognitive Therapy.

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