Culture and Mortality: Suicide

Culture and Mortality, Part 2: Suicide

This is the second of four articles about Culture and Mortality

Yes, the statistics on the rising rates of suicide in the United States are very concerning. It appears to me that we learn the same lessons over and over and over again. Without a moral compass, we are in trouble, big trouble.

We are in a culture that is often confusing, hyperactive, and without boundaries. As a result of this, many of our citizens are searching diligently for meaning in life, for a way to eliminate alcohol and other drugs from their life, and for a way to dampen their depression. Many of these folks have lost hope, and find themselves entertaining ideas about self-destruction; as I have said elsewhere, rehearsing a suicide plan is a hugely destructive place to be. This group of people lack self- efficacy, a sense of being in control and being capable of functioning successfully. They also have a deficient sense of well-being, of happiness. In many cases they are lonely; interestingly loneliness is an all too common negative mood state; some authors believe that it is a cultural epidemic involving not only loneliness but also isolation and alienation. Up to 40% of adults in the United States report feeling that way.

You may not know that physicians have among the highest rates of depression and suicide of any group; more than one doctor a day kills themselves. Overall, suicide rates in the USA have increased by 25% in the past 20 years. This is not a sign of a healthy culture, it is a sign of desperation, sickness, psychopathology, and hopelessness.

Risk factors/ etiology for Suicide include:

·       Depression is a key risk factor for suicide. Suicide often stems from a deep feeling of hopelessness. The inability to see solutions to problems or to cope with challenging life circumstances may lead people to see taking their own lives as the only solution to what may really be a temporary situation; and most survivors of suicide attempts go on to live full, rewarding lives. Dopamine is the neurotransmitter pathway to pleasure and may be interrupted in folks with depression. This, clinically significant depression, is without question, the most common reason people die by suicide.

·        Psychosis: Evil inner voices often command self-destruction for reasons that are difficult to understand. Psychosis is much harder to mask than depression, and can arguably be even more tragic. The worldwide incidence of schizophrenia is 1 percent and often strikes otherwise healthy, high-performing individuals, whose lives, though manageable with medication, are often derailed. Schizophrenics are just as likely to talk freely about the voices commanding them to kill themselves as not, and also, give honest answers about thoughts of suicide when asked directly. Psychosis, too, is treatable, and usually must be treated for a schizophrenic to be able to function at all. Untreated or poorly treated psychosis almost always requires hospital admission until the voices lose their commanding power and until the associated delusions lose their potency.

·       Substance abuse (Addiction):  Although many addiction treatment programs will not accept clients with recent suicidal behavior, up to 40% of patients seeking treatment for substance dependence report a history of suicide attempts. Several predisposing and precipitating risk factors such as marital and interpersonal relationship disruption, occupational and financial stressors, recent heavy substance use and intoxication as well as a history of previous suicide attempts and sexual abuse combine in an additive fashion with personality traits and mental illnesses to intensify risk for suicidal behavior in addiction patients. Major depression, bipolar disorder, borderline personality disorder and post-traumatic stress disorder are especially associated with suicidal behavior in people with addictive disorders.

·       Chronic pain (CP). Studies indicate that suicide ideation, suicide attempts, and suicide completions are commonly found in chronic pain populations. In addition, a number of controlled studies about suicide completion rates indicated that CP may be a suicide risk factor. Finally, a review of known suicide risk factors from other populations indicated that CP populations commonly exhibit other suicide risk factors. Psychiatric examiners should consider CP to be a potential suicide risk factor.

·        A family history of suicide

·        A prior suicide gesture that is often a sign of impulsivity.

·        Made a mistake: This is a recent, tragic phenomenon in which typically young people flirt with oxygen deprivation for the high it brings and simply go too far. The only defense against this, it seems, is education.

·       Impulsiveness often plays a role among adolescents who take their life. If a person deemed at risk due to any of the above risk factors exhibits sudden mood changes—even a suddenly upbeat mood—or completely new behaviors, they may be actively suicidal. Those who speak about being a burden to others, having no reason to live, feeling trapped or in unbearable pain may also be contemplating suicide.  Often related to drugs and alcohol, some people become foolish and impulsively attempt to end their own lives. Once sobered and calmed, these people usually feel emphatically ashamed. The remorse is often genuine, but whether or not they'll ever attempt suicide again is unpredictable.

·       A cry for help. and don't know how else to get it. These people don't usually want to die but do want to alert those around them that something is seriously wrong. They often don't believe they will die, frequently choosing methods they don't think can kill them in order to call attention to their challenges, but they are sometimes tragically misinformed. For instance, a young teenage girl suffering genuine angst because she feels lonely or has gotten into a devastating fight with her parents, may swallow a bottle of Tylenol—not realizing that in high enough doses it can be lethal.

·       A philosophical reason to die. These people aren't depressed, psychotic, maudlin, or crying out for help. They're trying to take control of their destiny and alleviate their own suffering, which usually can only be done in death. This is a reasoned decision that may be prompted by a painful terminal illness where there is no hope of reprieve.

·       Stress: we see that a number of successful suicides were related to acute stress in a person who may have poor coping skills, a co-existing depression, and a history of troublesome relationships. This person may have abruptly lost their job, have been rejected in a critical relationship, or may otherwise have had a financial setback, an ego insult, or a narcissistic affront that is highly anxiety producing. Stress-related diseases have been increasing for decades; these include heart disease, hypertension, obesity, diabetes, addiction, anxiety and depression.

·       Perpetrators in mass shootings are not only homicidal, but clearly have some level of awareness that they will lose their lives in the process. They are suicidal.

·       Suicide Contagion is an increase in suicide attempts and completed suicides following exposure to a suicide in the media or one’s personal circle. The suicide of a prominent celebrity or a member of a specific community, such as the military or an elementary school, have been shown to correlate with a rise in suicides. Although many studies have reported the correlation, they cannot conclude that exposure caused the elevated rates. Those who are especially susceptible to suicide contagion, also referred to as copycat suicide, include adolescents, people who already struggle with suicidal thoughts, and people with mental health conditions such as depression, bipolar disorder, and post-traumatic stress disorder.

So, How do we engender hopefulness and a sense of well-being in all age groups … in an increasingly complex world?

References:

·        Fishbain DA: ‘The Association of chronic pain and suicide,’ Seminars in clinical neuro- psychiatry, [01 Jul 1999, 4(3):221-227]

·        Mohler, R. Albert: ‘Culture shift: the battle for the moral heart of America,’ Multnomah Books, 2011, Chapter 13.

·        Ornish, Dean and Ornish, Anne ‘UnDo It: how simple lifestyle changes can reverse most chronic diseases,’, Ballantine Books, 2019.’

·        Yuodelis-Flores C and Ries, RK: ‘Addiction and suicide: A review.’ The American Journal on Addictions, [02 Feb 2015, 24(2):98-104]

·        Zahler, William A.: ‘Health, Inertia and Information: Why are we sick?’ Create Space and KDP, published 2018. Chapter 8.

·        Zahler, William A: ‘Synergy and the Dynamics of Lifestyle Change’, Create Space and KDP, published January 2019,  Chapter 8.

William Zahler, MSW, ACLM

November 2019