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“April is the cruelest month,” wrote T.S. Eliot about his depression, suggesting that his suffering was profound. The word “suicide” comes from the Latin, which means “self-murder.”
Why are suicides more common in spring and early summer when sunshine and daffodils appear, not December when days seem their darkest? Physicians have wondered about this for years and believe that changes in neurobiology occur that can mobilize into action someone who has thought of suicide but lacked the energy to act upon their thoughts. These individuals may experience a contrast between the renewal of light and life around them and emotional impoverishment and darkness within them.
In the US, we have about 30,000 suicides per year or 80 per day, making it the eleventh leading cause of death. Women attempt suicide three times more often than men but men are four times more likely to die from the attempt. Two out of three men use a gun while women prefer overdoses or poison.
What are the causes of suicide? Dead men tell no secrets so the story of suicide is left to be told by others. Kay Jamison, a psychiatry professor at Johns Hopkins who has struggled with bipolar disorder and suicidal thinking herself, writes in her book Night Falls Fast that predisposing temperament, genetic vulnerabilities and psychiatric illness can be a lethal blend. Thomas Joiner, a professor of psychology at Florida State University wrote a book Why People Die by Suicide. He hypothesizes that cognitive distortions such as perceived burdensomeness, social disconnection, isolation and loneliness along with developing a capacity for lethal self-injury are factors. A loss of a relationship, a job or social status can further set the stage for action. Depression, anxiety, psychosis hopelessness, medical illness or sleep difficulties may contribute to suicidal thinking. Alcohol or drug use may reduce inhibitions to action. Access to a gun or drugs provides the means.
Joiner describes the suicide of his father in 1990. His father had recently lost a job, a humiliating experience that distanced him from people he had thought of as friends. His father took a knife from the kitchen, drove the family van before dawn to a deserted parking lot, slit his wrists. When that failed, he punctured his heart. His father had a long history of untreated depression alternating with hypomania. He had lost his identity as a good provider and feared being a burden to his family. He had gradually withdrawn from family and friends. Joiner describes a series of painful experiences his father endured that he believes desensitized his father to the pain of cutting himself.
For college students, suicide is the second most common cause of death. College students are particularly at risk because they may experience their first episodes of depression and anxiety away from home. They may have the stress of classes, social life, changes in sleep along with increased alcohol intake. They may lack the maturity and problem solving skills to cope with the problems of college life. Dori Hutchinson, a Sargent College assistant adjunct professor and director of services at the Center for Psychiatric Rehab, was awarded a grant to establish the Boston University Suicide Prevention Program. The aim of the grant is to increase awareness of depression and suicide among college students. Students are being trained to listen carefully to their peers for themes of sadness, difficulty coping and hopelessness and to make a referral to Behavioral Health.
The treatments for suicidal intent are several, including inpatient hospitalization if clinicians believe it is necessary to save someone’s life. Other treatments include medication for psychiatric conditions and various types of psychotherapy. Individual cognitive behavioral psychotherapy can address the cognitive distortions and alleviate the patient’s acute misery. Group, family or couple therapy can address social isolation and relational or occupational problems. Treatment for substance abuse may be indicated. In severe cases, ECT (electroconvulsive therapy) is an old but effective treatment.
Depression is a serious and life threatening illness. Even with the best of treatment, some people who are resolute will die, leaving a painful legacy to their survivors.
The prevention of suicide occurs at many levels. The BU Suicide Prevention Program is an example of community education in prevention. Behavioral health clinicians, including psychiatrists, social workers, nurses and ancillary staff can assess and treat depression and other factors that may cause an individual to harm themselves. On a national level, the National Institute of Health has a strategy with goals and objectives to reduce suicide.
by Bonnie Teitleman