Suicide and its Prevention

Suicide and its Prevention

 

Suicide is one of the leading causes of death in the world and is on a rise. It is a harsh truth that we need to address on a large scale. Approximately 1 million people die by suicide each year. In the US in 2018, 48,344 people suicided, a rise from 42,773 in 2014, according to the CDC's National Center for Health Statistics. Nationally, the suicide rate increased 25.4% from 1999 to 2016. 1,39,123 people died by suicide in 2019 in India. In India, the number of suicides increased by 3.4% in 2019 in comparison to 2018. The rates are on a rise and the rate is high in women than in men worldwide. 

 

What drives people to suicide? As Freud says, one can be driven by Eros or Thanatos. Eros is a state where one is driven by the passion to connect, love, and reproduce. It is associated with positive emotions of love, good behavior, cooperation, collaboration, and harmony. Thanatos is a state in which the person is driven by death urge or tendency to move towards death. Thanatos pushes a person towards extinction and an inanimate state. Are you primarily driven by Eros or Thanatos? 

 

How do we study Suicide? We study using “retrospective analysis as psychological autopsy.” Another way is to study the people who survived suicide and asking them their thoughts, decisions, and life events. The survivors may still be causing non-suicidal self-injuries or taking actions where one does not commit suicide but does self-sabotage. It is done usually to release stress. Studying these behaviors would help analyze the mentality of attempters. I personally feel that even though I have not attempted suicide physically when painful events happened, I started showing symptoms like withdrawing from life, failing in my studies, career, etc. In long term, I suffered from severe painful symptoms of self-sabotage, especially, life. I can see that I made some severely wrong decisions where I killed my “life” and moved from abundance to scarcity in a short time. Analyzing our own stories would help find the reasons for self-destructive behaviors and can be extrapolated to find the reasons for actual attempts.  

 

What are the signs of suicide? Relationship failures, financial losses, and the death of loved ones are some of the major factors. If there is a family suicide history, it is highly likely that future generations can also attempt. More than 80% of the people who suicided had attempted it earlier. Therefore, if one has attempted once, it is highly likely that he can attempt again. If we take note of suicidal tendency symptoms, we can predict them, help, and save lives. If someone withdraws from regular productive behaviors and engage in wasteful and risky behaviors, take note of the person. The person may show sudden unexplainable mood swings and thought changes. He could be seen sad, anxious, tensed, and frustrated. He could be over-sensitive, get hurt for silly reasons, and easily get embarrassed. He could conclude that “my friend hates me,” “everyone hates me” to “no one will ever love me again in my life.” We can note Dichotomous thinking - thinking in terms of “black or white,” or “good or bad,” or “lost” or “gain”. If the person faces an immediate loss of a loved one or a natural disaster he may just feel “life is done.” Such a person might enter into a hopeless state and if sustains for a long period of time, mental illness often appears. Such a person could feel extremely meaningless and enter into a state of no self-awareness. He may not recognize himself. It is recorded that 70% of suicide attempts are done by people with unipolar or bipolar depression. Schizophrenia is also another cause of suicide attempts (10%). Chronic alcoholism adds up to 20% of the suicides. The risk increases if the person has multiple disorders - a combination of posttraumatic stress disorder (PTSD), panic disorder, schizophrenia, or borderline personality disorder. 

 

What Are the Underlying Causes of Suicide? Selective abstraction, amplifying events out of proportion to reality, is another reason for quick attempts. Many inculcate things over-scaled and destroy oneself. If the person would have analyzed it deeper, he would have recognized that the reason was trivial when seen from a different angle or a larger scope.  For example, a person may worry about money excessively unknowing that he can earn high once he goes through a certain period of time in life. According to the Psychodynamic view, suicide effects from depression and anger at others turned inward. When we do not have outlets where we can express it through, it turns inwards. Anger could be any loss – loss of a loved one, objects, money, assets, etc. It can create self-hatred and depression and can eventually turn suicidal. Suicidal behaviors are related to childhood losses according to Freud. It could result in mourning or melancholia. In mourning, a person feels their pain for the loss in an external way whereas, in melancholia, a person feels their pain in an internal way. The pain of loss in melancholia is felt within the unconscious, which means that the person may not be aware of the intensity of the grief. The person may not have the skill and capability to process grief by the conscious mind. The loss is taken very personally, suppresses the pain and it remains unapparent. The person procrastinates experiencing the pain. As the person loses awareness of the cause of the pain, it very often becomes directed towards the self. According to Durkheim, attachment causes suicide. One may feel isolated or alienated. The person may not see any way ahead. He may perceive that he is burdened by the world and is unsupported. One can alleviate the impulsion if he becomes aware of these factors. 

 

While children don’t have the tendency to suicide, the rates in adolescents are high. About 12 percent have persistent suicidal thoughts, 4 to 8 percent make suicide attempts, and 8 of every 100,000 teenagers commit suicide yearly in the U.S. The reasons include stress, anger, addictions, and substance abuse. Mental illness is another factor - clinical depression, low self-esteem, and hopelessness prevail. Other factors of suicide include low college academic performances, losses in sports and games, and other embarrassments. Lack of good relationships, love failures, and weakening family ties also cause suicide. Availability of alcohol and drugs and over abuse is another major factor. The rates are high among middle-aged people as well possibly due to the middle-age crisis. Among the elders, there is a high rate of suicides due to illnesses, loss of loved ones, loss of job, social status, finance, etc. 

 

Among various therapies, psychodynamic therapy is my favorite as it addresses the underlying core reason – lack of awareness. Cognitive-behavioral therapy by Beck if applied using mindfulness-based methods could also be effective. Family therapies and group therapies also help. Music therapy when combined with dance also could help. Therapies, if applied early, can help reduce psychological pain, gain a sense of hope, and keep the patient alive.