Suicide Part II

Suicide, part II is a continuation of last week’s post that I divided to ensure greater ease of reading.

Mental illness is a physical illness with psychiatric symptoms that affect thinking, feeling states, fears, coping strategies, energy levels, sleep, perception, concentration, libido, and general activities of daily living!

Our brain has billions of nerve cells, called neurons and receptors on them, that can become dysfunctional.  Neurotransmitters are chemical messengers that these neurons have to have to transmit quadrillions of transactions between them at given time for our human bodies and mind to even function or maintain life.

If any of these systems becomes less than perfect, humans will feel some symptoms from mild to severe depending on the severity of the dysfunction.

Neuronal dysfunction may be due to inherited tendencies, due to immense chronic stressors, either emotional or physical, drug use, traumatic events or perhaps even to inflammation, which is currently being looked into by research.

Bipolar Disorder I and II, Major Depression, Dysthymia(chronic mild depression), Anxiety and Panic Disorders, including OCD(Obsessive Compulsive Disorder),  and Alcoholism have tremendous bodies of research backing up the inherited tendencies of these mental illnesses.

Schizophrenia and drug addiction are not fully conclusive to these inherited theories yet.

Certainly, opioids that creat addiction, can change some of the physical pathways of neuronal transmission, as well as amphetamine-type drugs that can augment the severity of any mental illness or even be a causal agent or trigger.

The biological aspects of mental illness can even be influential on someone’s personality.

I feel we are born with certain personality templates, but personality and self-esteem are very influenced by early childhood relationships with parents and later with peers.

Major depression can distort perception of how the patient sees themselves in relation to family and friends.

The majority of depressed suicidal patients are convinced that they are a burden to family and that others would be better off without them.

They also feel shame and a weakness that they can’t untangle themselves from the deepening cloud imprisoning them.

Drug addicts will also feel intense shame and guilt for putting their families through their painful ordeal.

The bottom line, is they and many who have suffered from depression, including me, know very well that in reality, people do not want to hear about their troubles with depression.

So depressed people learn to hide behind smiles that they only feel obligated to show you, out of shame, out of fear, or out of letting others down with their troubles and depression.

Teens who suffer from chronic bullying may also hide their despair and humiliation.  Without intervention, they can be at high risk for suicide.

In dealing with friends and family either you know or suspect as having depression, talk to them heart to heart and express your concern, making sure they seek professional help

Do not be afraid of asking them if they have ever thought about killing themselves.  You will not be putting any ideas in their head.

Actually, if they have had suicidal thoughts, that would give them permission to safety talk to you about that.

Always take any threats of suicide seriously.   Better to overreact with concern and taking action, rather than dismiss.

If they are family and in treatment, let their therapist or psychiatrist know your concerns.   If you are a friend, let a family member know of your worries.

If you live out of town from the depressed person and they are threatening to harm themselves, call the police to check on them, called a welfare check.

Suicidal patients need to be hospitalized until treatment becomes effective enough to alleviate any further suicidal thoughts.

In dealing with American private insurers who want to get patients out as quickly as possible, this is a gross problem I encountered.

Once out of the hospital, stay in close contact with them, with daily calls and visits. Ask questions and yes, ask about suicidal thoughts reoccurring.

Make sure they go to their follow up appointments or outpatient groups.

If you are a close family member, make sure they are taking their medication as prescribed by checking the bottle, trashcans, etc.

Patients who are intent on killing themselves may lie to you or even their therapist or clinician about taking medication, pretending to swallow it and then spitting it out.

If they own guns or have access to guns of others, make sure they are not easily available, by locking them up and warning friends and family.

Encourage depressed persons to talk about their depression, their fears, their anxiety, and their fears.

  Express empathy and compassion, to create a safe haven for them to be heard.

Stay in very close contact with a depressed person, and let them know they can call you anytime.

You don’t have to offer solutions, but hope, yes!  If you have personally suffered from a mental illness, sharing it with them is helpful and may give them hope of feeling better.

People feel more drawn to talk about their depression to others who they know has suffered from it too.

Getting help for depression is imperative, and especially for anyone who has expressed suicidal thoughts.

Suicide risk must be evaluated with these patients depending on several factors.

First, is evaluating if suicidal thoughts or fleeting without intent, or they reoccurring with intent.

Second is knowing the psychiatric history of the patient, especially if they have suffered from depression with suicidal ideation before, and if yes have they had any gestures or attempts.  Have they been hospitalized before?

Thirdly, is taking a good family history to know if other members of the family related by blood have killed themselves or suffered from severe depression or mental illness with a gesture or past attempts.

Suicide is often seen running in families, with the Hemmingway family being an example, that I wrote about in a previous post.

Fourthly is evaluating the type of support system the patient has, which is very important.

Close family and friends can be lifesavers to the severely depressed.  Strong spiritual beliefs can provide the patient with a core of adhesion and support as well.

Those who are separated, going through a divorce or romantic rupture or in any way feel isolated are further red flags that increase the risk scale.

Evaluating the degree of hopelessness the patient feels and the degree of reoccurring suicidal thoughts are as well very significant.

Post Traumatic Stress Disorder in vets with combat exposure, with severe depression, and or along with substance abuse need further evaluation.

Last, but not least is how well the therapist knows and trusts the patient.

All of these risk factors are taken into consideration to evaluate the degree of risk.

If high, or medium high, then hospitalization is necessary.  In low or medium with strong family support, outpatient treatment may be possible. In patients without family support system firmly in place, hospitalization is best.

Despite the very best evaluation and psychiatric care, some patients will go on the kill themselves regardless of all of these interventions and efforts.

Mental health providers take these failures to heart and grieve all with the family. Depression with strong suicidal intent sometimes can be resistive to everything we can do, just like some cancers.

For family members, friends and clinicians, the bottom line is that we are not God.

Despite our best efforts, love, care, and treatment we will not be able to save everyone.