One of the most painful human experiences that most of us have had is finding out that a person known to us, sometimes closely, has committed suicide. In the first place, it is particularly disturbing for the human psyche to come to terms with the fact itself because, as a species, we are so specifically wired for self-preservation, not for self-annihilation. What can make it more painful as well as more confounding is that, all too often, the tragedy seems to have come right out of the blue. We may have, as recently as that very day, spent time with the person, and (s)he may have appeared relaxed, upbeat and normal. It becomes even more baffling if the person had both, a loving family and tremendous personal success. There may have been no note to explain the decision, or to assuage the heart-wrenching pain of loss. It is natural, in our utter shock, to wonder: “What did I miss?” and “What could I have done?”
In many cases, the answers are “Nothing” and “Nothing”. The impulse to suicide is a very complex and often unpredictable one. Many suicides are impulsive acts, with the decision to end one’s life being made just a few hours or even a few minutes before the act. Even when the planning has been a long time in the making, the people who are most intent on committing suicide know that they have to keep their plans to themselves if they are to carry out the act. Thus, those who are most in need of help may be the toughest to save.
On the other hand, however, it is also a fact that family members and friends have reported in research interviews, that upon reflection (i.e., with hindsight), they were able to see the indicators of their loved one’s path to suicide more clearly, even though while alive the person did not appear to be hurting. In fact, in many cases he or she appeared to be doing just fine. But that’s really only because they were incredibly good at masking their symptoms. The tragic fact is that most suicides (though not all) occur with at least some type of outward signal to friends or family members. Unfortunately, all too often, friends and family are unaware of these warning signs (or do not take them seriously) until it is too late.
So the challenge has always been: how do we identify those who are at risk for killing themselves, and how do we prevent it from happening? Two types of information equip us with some answers.
- The risk factors for suicide
- The warning signs
Here’s a closer look at each of these.
THE RISK FACTORS
Risk factors are characteristics or conditions that increase the chances that a person may try to take his life. They comprise two categories:
Not everyone who has a mental-health condition will commit suicide; nor do all those who commit suicide suffer from a mental illness. However, mental illness increases the risk for suicide. Although all mental disorders are associated with an elevated risk of suicide, certain disorders carry with them a remarkably high lifetime risk. They include:
Depression. This is the most common mental-health condition associated with a raised risk of suicide, especially when it is undiagnosed or untreated.
Substance abuse disorders
Apart from mental health conditions, serious or chronic illness (e.g., cancer or congestive heart failure) and/or disabling pain can make suicide look like the gateway to permanent relief.
A previous, non-lethal suicide attempt. This is thought to be a serious contributor to the risk of another attempt. This is how it is largely explained: In addition to suicidal desire, a person contemplating suicide needs what is called the “capability for suicide”, which involves both a lowered fear of death and increased physical pain tolerance. Suicide hurts, literally. A previous attempt, by habituating the person to physical pain, bolsters his “capability for suicide”.
- Stressful life events, such as a death or job loss
- A personal crisis, especially one that increases a sense of isolation or leads to a loss of self-esteem (e.g., a break-up or divorce)
- A prolonged (chronic) stress situation which may include harassment, bullying, spousal abuse, relationship problems
- Access to lethal means, including drugs
- A family history of suicide
Exposure to another person’s suicide, or to graphic or sensationalized media accounts of .the death. Celebrity suicides, in particular, have been found to spark copycat suicides in some cases.
Teens are especially susceptible to the risk of cluster suicides. WHO data suggests that 1 to 5% of youth suicides occur in clusters. Since the suicide of a friend or age peer is often a traumatic experience for adolescents (many of whom are left bewildered by the lack of warning signs), the death of one teen might influence other teens feeling suicidal.
The red flags of suicide can be bracketed into three categories.
Threats or talk of death or suicide, such as “You won’t need to worry about me much longer”, “I’d be better off dead”, “I don’t care anymore,” or “If I see you again…” Other statements might refer to being a burden to others, feeling trapped, or experiencing unbearable pain.
Moods and feelings
A person who is considering suicide often displays one or more of the following moods and / or feelings:
- Self-loathing: Feelings of worthlessness, guilt, shame, and self-hatred
- Loss of interest: Feelings of helplessness, hopelessness, of believing that things will never change or get better, that nothing one does makes a difference
Frequent mood changes
A sudden brightening of mood after a period of being depressed. This generally happens when the person has taken the decision to end it all, and feels a great burden is lifted off his shoulders
- Unusually risky behaviour, such as buying or handling a knife, stock-piling pills or driving recklessly
- Abusing alcohol or drugs
- Pacing, agitated behaviour; sleeplessness for several nights
- Putting one’s affairs in order, such as saying goodbye to friends as if they won’t see them again, giving away prized possessions and /or writing a will
- Withdrawal from activities and relationships – i.e., social isolation, particularly if self-imposed
- Neglecting home, health, finances, or pets
- Aggression: Actions or threats of assault or physical harm
- Looking for a way to kill thems
- elves, such as searching online for materials or means
- Writing a suicide note
As far as behaviour is concerned, the bottom-line appears to be: Watch out for one or more changes in normal behaviour. This is of sharpest concern if the new behaviour is in the context of a painful event, loss, or change. People who exhibit one or more of the warning signs, above, are often communicating their distress. This is a cry for help that shouldn’t be ignored.
WHAT YOU CAN DO
If you find that any of the warning signals indicate suicidal ideation in you (i.e., that you are thinking about suicide), go to a hospital emergency room immediately, or ask a supportive family member or friend for help, or contact a suicide prevention helpline service like the Samaritans.
If someone you know is talking about suicide, do not leave them alone. Take seriously any comments about wanting to die. It is a myth that people who talk about committing suicide do not go through with it. When it comes to suicide concerns, it’s always better to err on the side of caution. If you suspect it, address it.
Another common misconception is that once suicidal persons undergo treatment and seem to be getting better, they are no longer at risk of suicide. However, treatment sometimes provides a suicidal person with the energy needed to complete the suicide. Also, when a person is resigned to death, this acceptance can release anxiety and provide the appearance that the person is getting better. Keeping appointments and taking medication regularly are especially important for the person at risk.
Accepting that you or a loved one is suffering from a mental illness can be incredibly difficult, especially in a modern-day milieu where we often try to mask negative emotions and put on a brave front. Shame, fear, denial, and other factors often prevent individuals or their families from seeking help. But help is available and treatments for several mental illnesses are more effective than ever before.
(The author, a former editor of 'Health & Nutrition' magazine, now works as a counselling therapist)