Understanding what drives someone to suicide

Dear friends - 

After Cliff died, one of the big questions I found his family, friends, and myself asking was why had it happened? What was going on in his life that had pushed him to his death?

In previous posts I've written about four areas of action that I believe could have made a big enough difference to prevent Cliff's death and could prevent other deaths. These don't, however, address the question of what drove Cliff to take his own life.

It hasn't been difficult, in retrospect, for me and others to think of many obvious and potential stresses affecting his life. His work situation presented some obvious ones, which I've discussed in a previous post. Could other situations have been factors in his death, too? A legal matter he'd been dealing with for nine months previous? A knee injury that was still interfering with skiing and hockey? A bump in his relationship with someone dear? Getting older? A car accident we witnessed? Did he have fears about our budding life partnership?

While any and all of these factors can cause stress, frustration, sadness, and fear, we all have similar issues with which we grapple. Even the combination of a number of these situations does not typically lead to a person's death. Why, then, did Cliff die, and which, if any, of these factors were direct contributors?

Thomas Joiner's book Why People Die by Suicide provides insight about the factors found to increase a person's risk of dying by suicide (not just thinking about it or even attempting it). Reading this helped me get clearer in my own mind about which issues in Cliff's life I believe to have have been normal stresses, and which could have forewarned us that he was at high risk.

I want to emphasize that this is my interpretation of events. Others may have different perspectives and insights.  If you think I've missed something or am wrong about any of this, please let me know.

Factors in Cliff's Death

1. Threat of job loss

While there were a number of stressful situations that happened for Cliff in the year or two preceding his death, his reaction to most of these was within a normal range of emotion: Frustration, sometimes anger, probably some fear. Some of these may even have affected his sense of identity. But the one that most closely preceded the unmanageable level of anxiety he experienced that fall was the news that his organization's contract was expiring and his job was at risk.

The fears and fixations that Cliff expressed while he was in that anxious state were directly related to the threat of job loss: Fears about finding work, money, and physical security. The extreme anxiety reduced his ability to concentrate. He had always been concerned about whether he was a valued and respected employee. This concern escalated to a fear that management didn't value him, didn't want him, no one would give him a good reference, he would be unable to get another job, and he would end up on the street.

If an event triggers an emotional crisis, it is usually an event of some magnitude: Job loss or threat of job loss; a spouse or significant other ending a relationship; the death of someone very close; extreme financial difficulties. For Cliff, the threat of job loss attacked not only his financial stability, but his sense of belonging, his sense of having a place in the world and being a valued contributor. People who identify strongly with their careers -- doctors, lawyers, dentists, police officers, firefighters -- are at higher risk of a crisis when they perceive their career as being threatened.

2. Anxiety

The news that Cliff's contract was expiring triggered an unshakeable fear or anxiety that quickly became his constant companion. Anxiety, which many of us may think of as the most normal of psychological disorders, actually carries with it a greater risk of suicide than depression when it is severe. This may be for several reasons.

First, fear triggers physical and psychological processes in preparation for fight or flight. The mind becomes hyper-alert and focused on the perceived threat. The body shuts down any functions unnecessary in the short term so that all energy is in reserve for a physical response. When a quick response is needed, this physiological response may be very helpful or at least manageable. When fear is overwhelmingly intense and unmanageable, or when it persists over weeks and months, the physiological response becomes debilitating.

Some of the primary physical functions to be disrupted are digestion and sleep. Cliff quickly developed insomnia, stomach pain, and other digestive issues for which he sought medical help. Not getting proper nutrition or sleep over an extended period further undermined his ability to recover. Insomnia is particularly detrimental to one's mental health and physical stamina. At times, the anxiety was so extreme that Cliff felt his skin was burning and he would pace the house rubbing his arms and talking.

His hyper-focus on the perceived threat of job loss and associated fears prevented him from being able to either believe that other options and outcomes were possible, or even just put aside his worries for a while and relax or play. The anxiety was so overwhelming that he found it difficult to even imagine successfully competing for another job. Fear undermines confidence -- both one's own and others'. Thus a vicious cycle was created, and the barriers to Cliff being able to respond effectively became greater and greater.

Finally, persistent anxiety can lead to depression, yet the symptoms of anxiety mask that depression, making it more difficult for others to identify or diagnose.

Many experts believe that suicidal ideation is a relatively normal response to overwhelming psychological or physical pain. The unrelenting anxiety created psychological pain and persistent physical discomfort for Cliff. Numerous self-help techniques, medications, and even hospital treatment failed to free him from the fear and pain.

3. Childhood physical and psychological abuse

This part of the story happened long before I knew Cliff, and is not mine to tell. What I can say is that, very sadly, physical and psychological abuse, including ostracization and neglect, were part of Cliff's and his siblings' childhood experiences. Several studies have shown that these childhood experiences, especially when the abuser is a parent, are associated with increased suicidal ideation and behaviour in adulthood, and an elevated risk of death by suicide. Some of the seeds of Cliff's death were, I believe, planted much, much earlier in his life.

E.g. Childhood abuse raises adult suicide risk
The Relationship of Childhood Abuse to Impulsivity and Suicidal Behavior in Adults With Major Depression

4. Fears of being a burden 

One of the paradoxes that Cliff was caught in as his situation worsened was the need to experience himself as capable and in control even as the anxiety diminished his ability to think clearly and respond effectively and the situation spiraled out of his control. As fears about competency and control heighten, one may respond by trying to re-assert oneself in those areas. This is a particular danger for highly intelligent people who are used to being in control and to being very good at solving problems and managing difficult situations, e.g. doctors, lawyers, or, like Cliff, computer programming professionals. Attempts to reassert competency and control lead to help negation, the conviction that "I need to do this on my own," at a time when one is most in need of help.

For Cliff, being unable to control the anxiety on his own, having to go on medication, the possibility of being reliant on sources of income other than what he himself had generated, being hospitalized and forced to go on sick leave all undermined his sense of control and competency and further fueled his fears.

When repeated attempts to cope appear to have failed, psychological pain is constant, and things keep spirally downward, suicide may come to seem the only way to re-assert control.

5. Acquired ability to inflict lethal self harm

Thomas Joiner asserts that when a person's sense of belonging and sense of capability are threatened, many of us will experience self-destructive or suicidal thoughts. Nonetheless, the instinct for self-preservation and fear of death are incredibly strong. Although one may have a strong emotional and psychological response to feeling isolated and seeing oneself as a burden on others, this does not necessarily lead to suicidal behaviour.

According to Joiner, a person becomes at much greater risk of death by suicide if he or she has acquired the ability to inflict lethal self harm. This happens through repeated or severe injury or trauma, or through suicide rehearsals and attempts. While emotional and perceptual risk factors are more variable and subject to influence, once a person has inured him or herself to suicidal behaviours that person may always be more vulnerable.

Sometimes suicide attempts are seen as a cry for help; we question whether someone was "serious". This attitude can hinder us from responding effectively and compassionately. Any suicide rehearsal or attempt is a confrontation with one's fear of death, one that takes a person closer to being able to overcome that fear.

For Cliff, there were a number of events that contributed to his ability to inflict lethal self harm. The physical abuse he experienced as a child was probably the first of these. Then there was a motorcycle accident when he was 20 that left him with two broken legs and took months in the hospital from which to recover. During a particularly difficult period during his 30s, his sister tells me that he would show up with bruises on his face from bar fights that he may or may not have instigated. And by the time he died, Cliff had made two previous suicide attempts.

6. Hospital discharge

People at risk of suicide are very vulnerable at transition points in their care, for example in the first 48 hours after being discharged from hospital. This was the period in which Cliff died. Because there was no crisis plan in place, the discharge process was handled so casually, and no one close to him was informed this could be a vulnerable time, Cliff was alone and at the mercy of his volatile thoughts and moods.


From what I've learned, these are the factors that drove Cliff to take his own life. That does not mean his death was inevitable. Effective support, education, and intervention could have helped him ride through the crisis to a place of more stability and possibility. The biggest tragedy for all of us who knew and loved him is that did not happen.