With the recent suicides of two celebrities, Kate Spade and Anthony Bourdain, both of whom were at the peak of their fame, once again we find ourselves trying to understand one of the most mysterious causes of death — suicide.
Just last month, the Center for Disease Control issued its report on the dramatic increase in suicide, particularly in middle-age white males and in females.
It’s difficult to make sense of two disparate statistics — the significant increased use of anti-depressants among teens and adults, and a rising rate of suicide. According to the American Psychiatric Association over 13 percent of Americans 13 and older are taking anti-depressant medications. In the last 10 years, depression has been more widely identified and treated, both by primary care providers and by mental health specialists. Yet with all of this increased care, why isn’t the suicide rate declining?
As a clinical psychologist with 40 years of experience, I have worked with thousands of patients with depression. In the earlier part of my career, I ran an Emergency Services program where I evaluated hundreds of adults and teens who had suicidal ideas, intent or made gestures. My job was to evaluate their risk of suicide and establish a care plan.
The easiest individuals to help were those who expressed their suicidal thoughts and were open about their intent. But the teens and adults who ultimately did die by suicide did not disclose their intention. Indeed, they often denied that they wanted to die. Unfortunately, clinicians are no better mind readers than anyone else.
There are several risk factors that require close attention: alcohol or drug abuse, past history of suicide attempts, impulsivity, family history of suicide, recent major life losses (job, finances or relationships), insomnia, chronic illnesses or pain, or loss of reasons to live.
Unfortunately, our predictive tools and skills are far from perfect. Over my 40 years as a clinician, I have had a handful of patients take their own lives — teens and adults. I have mourned each one of these deaths. I join their family and friends as survivors of suicide.
In my experience, suicide often appears as an impulsive act — a bad moment, a loss of control lubricated by alcohol or drugs, a vengeful instant (in the case of a relationship breakup), or an overwhelming feeling that one cannot live one more instant in the present circumstances.
It is especially difficult to understand suicide in adults with children. How can someone take their life when they have children? Don’t they consider the impact that their death will have on their family? Sadly, adults who have unsuccessfully tried to kill themselves, tell me that in that moment, they feel that their children and family will be better off if they are gone.
Depressed individuals tumble into the Grand Canyon of negative and distorted thinking. They are lost in their biased thinking.
It is important to remember that we can’t see how depressed an individual feels. On the surface, they may look fine. Having all of the trimmings of success, does not in itself bring happiness. Indeed, it can offer a painful contrast to the way a person feels on the inside.
So what can family and friends do when they are concerned about someone?
Share your concerns with the family member or friend who appears depressed. Don’t be afraid to open up the subject. Contrary to popular belief, asking someone if they have suicidal thoughts does not spur them to start having these ideas.
Don’t bring up all of the positives in their life. This can actually make depressed individuals feel worse. It can increase their sense of guilt.
Show up. Stay connected, even if your friend or relative is withdrawn and isolative.
Make it easy for them to get help. Go with them to see a mental health professional, sit with them while they make a call, consult with a mental health professional yourself to get coaching, and be persistent.
Paul Schoenfeld is director of The Everett Clinic’s Center for Behavioral Health. His Family Talk Blog can be found at www.everettclinic.com/family-talk-blog.
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