Lesson 6: Suicide Prevention
Suicide claims a million lives a year worldwide, most resulting from depression This lesson looks at how to plan for a crisis and what you can do to help others in a crisis.
Steps You Can Take
The young man became so preoccupied with suicide that his concerned friends moved in and stayed with him day and night, making sure to remove knives and guns from his presence. As he stayed awake, agitated and delirious, they maintained a vigil for more than a week. Later, after the crisis abated, a friend invited the man to live in his lodging and helped start him on a career in law. The young man later went on to become sixteenth President of the United States - Abraham Lincoln. But that was then. Vice President Dick Cheney publicly acknowledged his suspect heart, but if he ever so much as took St John's wort to ease a mild case of the blues, you could safely bet your entire 401(k) voters would never find out.
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It was a pact made in good faith - two longtime friends, fellow individuals with bipolar, both resolving over dinner to be there for the other in time of need.
One of them twirls the scotch in her glass. Even as she makes the promise, she knows it is one that cannot be kept. She knows from her own experience that the pits of despair militate against a person seeking help, that one can barely crawl out of bed during the fury of a killer depression, much less get to the phone much less make other arrangements.
Many years later she receives a call from the man's wife. In the words of the author: "Jack had put a gun to his head ... Jack had killed himself."
The writer is Kay Redfield Jamison, who is both a renowned bipolar expert and bipolar patient. Her latest book is "Night Falls Fast - Understanding Suicide." Like Dr Jamison, our personal experience has made us reluctant authorities. We're all veterans of our brains going down on us. We know what it is like when our broken minds, desperately seeking the quickest way out, come within a degree or two of finality and its false promise of blessed relief.
In Jamison's words: "The reality of dying from suicide became a dangerous undertow in my dealings with life. When I was twenty-eight ... I took a massive overdose of lithium. I unambivalently wanted to die and nearly did."
According to studies by Elie Robins, 70 percent of patients who committed suicide mentioned the thought during the year prior to their death. Robins also found 60 percent of patients communicated suicidal ideation to spouses and 50 percent to friends, but only 18 percent to doctors and others. Accordingly, the authors of "New Hope for People with Bipolar Disorder" (Fawcett et al) advise:
"That means that if a loved one, relative, or friend talks to you about suicidal thoughts, that person may not be leveling with their doctor or therapist about such thoughts. If there is evidence of preoccupation, a suicide plan, or talk of lethal means ... take it seriously and consider it an emergency situation."
According to the Centers for Disease Control, suicide is the ninth leading cause of death in the US (more than 30,000 a year), well above homicide (at about 20,000 a year). Women will make the most attempts, but men will be by far more successful, by a margin of four to one. In teens and young adults, suicide is the third-leading cause of death, after accidents and homicides, more than all natural diseases combined.
We are talking epidemic numbers. At any given moment, five percent of the general population is suffering from a major depressive episode. Over the course of a lifetime, major depression will strike twenty percent of the population, numbers comparable to cancer and heart disease.
We are talking battlefield odds. Those in the highest risk category of major depression have an 85 percent survival rate, but the prospect of finding ourselves in the lucky majority brings us only small relief. The experience has exposed us to our worst vulnerabilities, and deep inside we no longer trust what tomorrow may bring. We may still be walking and breathing, but we have been as close inside death as this side of life permits, and our minds will never let us forget it.
We ponder the fates of the unlucky minority, and sometimes we say a prayer. We contemplate the tortures their brains exposed them to, and know for a fact that no God would ever hold judgment against them. For the time being we are the lucky ones, but tomorrow that may change.
Still, we do have a certain amount of control in managing tomorrow. We who have survived know what we are up against, and can plan accordingly. Following are some common sense guidelines:
In the Long Term
- Cultivate friends or family members you can call on should you find yourself in crisis. If you have no friends or family you can trust, then seek out a support group, live or online.
- About posting your cry for help on the Internet: Choose your site or mailing list very carefully. If you are new and posting to a very busy list, your appeal may be lost in the shuffle. At the opposite end, your message may go completely unread on bulletin boards with little or no traffic. It may take a few weeks before you establish a presence on a particular list or board. By then, you will probably be on email or ICQ terms with some of the members.
- Look up the numbers of various local suicide hotlines and keep them where you can find them. Familiarize yourself with the Internet crisis and suicide sites and bookmark the ones you like.
- Establish a close relationship with your doctor or psychiatrist. Ask yourself: is this someone you can call on in the middle of the night? Or, if not, will someone be there to respond to your call?
- Remove all guns and rifles from your home. According to the Centers for Disease Control, 60 percent of all suicides are committed with a firearm. This is not an anti-NRA message. We're just being sensible, that's all.
- The same principle that applies to firearms applies in part to medications. The tricyclic and tetracyclic antidepressants can be fatal in overdose. You may want to switch to a different antidepressant if you don't trust yourself. If you must keep certain medicines in the house, it may be advisable to turn them over to a loved one.
- Watch your thoughts and feelings very carefully. You may be able to pick up subtle signals in your mind, before a full-scale crisis overwhelms you. Actually visualizing the act should set off every warning bell.
In an Actual Crisis
All too often, a suicidal depression catches us alone and off-guard. Notwithstanding all we have to live for and all those who care for us, the brain in crisis has a perverse way of having us think the very opposite. To those of you who are in this state right now:
- Promise yourself another 24 hours.
- Now call a trusted friend or loved one or a crisis hotline. Remember, there is no shame in reaching out.
- Time is of the essence. Do not delay in seeking help.
- Be persistent. Do not be put off by the bad practices of some of the health system's gate keepers. You are there to get help and you are there to get it NOW.
- Take comfort in the fact that help is on the way. Your brain at the moment may not allow you to think hopeful thoughts. But it cannot keep out the knowledge that others are hoping on your behalf. This may be that precious one inch of life you can hold onto at the moment, the one that can eventually lead you to a tomorrow worth living.
Finally, bear in mind: Abraham Lincoln had a great support system. How reliable is yours?
