Suicidality

I woke up this morning reading about another suicide that occurred last night at the Eiffel Tower.  What is one of the most sought out beautiful sights in the world, became a vehicle of death to another desperate human being.  But, we are in the season as May and June have the highest rates of suicides.

What pushes these most unfortunate ones over the brink to self-imposed death remains elusive.

Most suicides are not impulsive but are the final end of a culmination of a sense of hopelessness.

Suicidal ideation is part and parcel of Major Depressive Disorder and the severe depressive states seen in Bipolar Disorder.

The majority of depressed patients think of suicide as a way of escaping their pain, but fortunately, most do not act on their suicidal thoughts.

There is always a thread of hopelessness and intense psychic pain that left unattended, can increase the risk of suicide.

Intense hurt and humiliation appears to fuel the majority of teen suicides, but can be seen quite often in adults who have suffered from humiliation and pain caused by loss of a job or love relationship.

Rejection, which is prominent from either of these is always accompanied by intense hurt, humiliation, and anger, masked or not.

Suicides that result from these instances are mostly fueled by an angry intent to get back, to cause pain to the people responsible for their loss and pain.

Sometimes there is no real identifiable loss or hurt.   Patients who suffer from major depressive disorder or the depressive states of bipolar disorder can often have a cognitive distortion that paints everything in their life extremely negative.

They see themselves as failures, regardless of their successes and accomplishments.  Others hang on to intensified guilt and self-recrimination.

Depression takes away their any sense of worth, and they see themselves as a burden to their family or loved ones.

I have often heard them say that their family would be better off with them, a completely erroneous fact if they knew the horrible and forever implications on the lives of loved ones left behind.

When I hear this, I tell them their suicide is a very selfish and punishing act that will leave unhealed scares forever in others left behind, especially children and parents. ..

I remind them that they will set up for other family members to take the same way out, that will affect generations to come.

My personal opinion is that consciousness and whatever pain we have goes with us despite leaving a physical body, therefore suicide does not “remove” the pain.

It only creates more pain, not only for the deceased in cosmic dimensions but ties them to the very pain they so desperately wanted to leave behind.

As a therapist, I go directly to the point whenever I have a patient with suicidal thoughts.

I want to know in what ways they see themselves dying, for how long have they had these thoughts, and have they ever tried to hurt themselves before.

Do they have a plan?   I also ask if they find themselves driving careless or taking other risks usually avoided in the past.

It is also imperative to take a good family psychiatric history to uncover mental illnesses in family members, which is a part of the initial interview anyhow.

I want to know if there has been any completed or uncompleted suicides in their family.

Whenever I have a patient who has suicidal thoughts, and has a past history of suicidal gestures and even worse with a family history of a completed suicide, the risk of suicide can be considered the greatest.

If there is a plan, then they do not leave my office without being accompanied to the hospital. Period.

Others with much less risk are contracted with to not hurt or kill themselves, but I must admit I do not sleep well with these types of patients and want to see them more often.   There is constant worry and fear for them.

Medication should be initiated as soon as possible, as there is no time to be loss “waiting” for things to get better.

Fortunately, most of the antidepressants used today are safe against overdose to death, which was a real culprit with the old tricyclics.  I

n my practice, I have not seen antidepressants “causing” any suicidal ideation, as this is usually present before even any initiation of the drug.

The bottom line is that antidepressants save lives and I am grateful that we have them in our treatment options.

As a family member do not be afraid to ask a depressed one about thoughts of dying, do not worry that you are putting those thoughts in their head.

Get them to a clinician to be evaluated and stay closely involved with them. Do not take no as an answer.

Make sure they keep their followup appointments and that they are taking their medication as prescribed!

Engage them in talk at much as possible.  Be with them often, do not let alone for long periods.

When they feel better, encourage them to get out of the house and make them go with you on walks and to other activities.

Physical exercise is very important!

Most important is to remove any guns or weapons to an unknown safely locked space.

None of us are God, and only can do so much.  Despite the best healthcare available, which I can only presume Mary Kennedy had, suicides will continue to occur.

Nevertheless, I will continue to do my part in prevention and treatment, along with informing others about the subject in any way I can.