Magazine article Clinical Psychiatry News

Suicide: A Surprisingly Ambivalent Topic

Magazine article Clinical Psychiatry News

Suicide: A Surprisingly Ambivalent Topic

Article excerpt

Recently, we acknowledged National Suicide Prevention Week (Sept. 10-16, 2017). Few psychiatrists would disagree that suicide is a bad outcome, that it is often preventable, and that the loss and pain that follow an untimely act are nothing short of tragic.

It's also an epidemic on the rise, with more than 40,000 deaths a year, half of those by self-inflicted gunshot. Because 90% of those who suicide suffer from mental illness, one target becomes clear: We need to identify those at risk and make it easy for them to get help. Still, treatment is not a clear panacea; in the decades since selective serotonin reuptake inhibitors have become so readily available, suicide rates have risen, and many who die have gotten help of some type. The issue is a complicated one that reaches well beyond the arena of mental health.

Still, the suicide of a patient, friend, or family member is shattering, and psychiatrists hope to see this trend reverse. While to many of us, it's an all-bad thing, society at large has become a bit more ambivalent, if not conflicted, as to how suicide is considered.

Paul Nestadt, MD, a postdoctoral fellow in the Johns Hopkins Psychiatric Epidemiology Training Program, is a researcher on a study that correlated rural suicide rates with the availability of firearms (Am J Public Health. 2017 Oct; 107[10]:1548-53). "Suicide can happen when ambivalent suicidal thoughts dip over the threshold into behavior. In those key moments, the lethality of the nearest available method may determine whether someone dies, as illustrated in the United States by the predominance of firearms in the use of completed suicides." Yet it is not unusual for those who are against gun control to note that most firearm deaths are suicides, and therefore unlikely to be changed with gun regulation; they believe that individuals who want to die will find another way, despite research that indicates otherwise. At moments, it feels like they are saying these deaths don't count; people who have impulses to harm themselves will do so, and gun control is not an answer. Others, like Dr. Nestadt, contend otherwise, and say that limiting access to lethal means will make a difference.

Let's also consider the words we use. While the familiar term is to "commit suicide," the current thinking is that this is stigmatizing--people "commit" crimes --and family members of survivors often prefer the phrase "died of suicide." Is the change necessary? It is true that people commit crimes, but they also commit to relationships, and to any number of positive activities. I had not previously associated the word with criminal behavior, and the now-favored term changes suicide from an active event to a passive one. If changing the words helps lessen the survivors' pain, I am all in favor, but the loss and shame remain regardless of the phrasing.

Stigma may be a mixed thing when it comes to ending one's life. We would all like to see suicidal thoughts and intentions destigmatized so that those who suffer won't hesitate to get help. It's not clear, however, whether stigmatizing the completed suicide might serve as a deterrent to the behavior for some. When patients talk of wanting to die and are considering a method, they often add that they could not do this to their families. …

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