Last weekend I learned that a colleague had died by suicide the Friday before. I only knew him through conversations with others, had never met the man, but the news of his death has been very painful. A lawyer in his mid-50s, someone who had been successful in his career and risen through management levels, he had been struggling with anxiety and depressions for at least a year before he died. In contrast to Cliff, the organization he worked in is very aware of mental health concerns and suicide risk. He received the best support the people working in the organization knew how to provide.
I wrote the following in the wake of his death, an attempt to help others cope and a reflection of how my understanding of suicide has changed over the past 18 months.
Suicide Misconceptions
- Suicide is a choice.
Suicide is no more a choice than dying of cancer or cardiovascular disease is a choice. Someone who dies by suicide has been suffering from a severe, life-threatening disorder, and has not been able to receive the treatment or resources needed to survive.
- The person wanted to die.
It is the illness or disorder that puts someone in so much pain or distorts his thinking so that death seems to be the only option. Once people recover from a suicidal crisis, the vast majority are grateful and relieved to be alive, even if they survived a suicide attempt. This feeling may not come until the disease or disorder has been resolved, but when that happens it does come.
- A loved one or colleague found the body. Why would the person who died do that to them?
In trying to make sense of what's happened, we may wonder whether the person who died was trying to get revenge or express anger towards his loved ones, and particularly towards the person who found the body. While that may in some circumstances be a factor, it is more likely that the person who died was driven to act quickly, and wanted somewhere readily accessible where they had the resources to kill themselves and would not be interrupted. The suicidal crisis attacking him prevents him from caring about who will find the body, just as it prevents him from valuing his own life. - Someone who kills him or herself is weak.
Someone at risk of dying by suicide is under attack by her own thoughts and emotions. Everyday, she is fighting a battle to survive. This takes an enormous amount of strength and courage. If someone dies by cancer, that doesn't negate the strength and courage she or he demonstrated while living with the disease. The same is true for someone who dies by suicide.
- Why didn't he just take anti-depressants or talk to somebody?
Someone at risk of suicide has usually tried many types of treatment, therapy, and self-help techniques. Unfortunately, some forms of mood and anxiety disorders may only respond to specific medications, or may not respond to medication at all. Many mental health professionals, who we think of as experts in this area, have received little or no training in the treatment of suicidal crises. Someone in a suicidal crisis may question whether he is beyond or unworthy of help. Receiving ineffective treatment can reinforce those beliefs and worsen the crisis.
- Someone who is suicidal is beyond help.
Effective treatments are available. Dialectical behaviour therapy has been shown in randomized clinical trials to reduce suicidal thoughts and behaviours. Sometimes medication can be very effective in treating or preventing a suicidal crisis. Restricting access to firearms, poisons, medications, and other means of dying has been shown to be very effective in reducing deaths. Even a change in circumstances can relieve the suicidal crisis and enable the person to recover.
People being attacked by a suicidal crisis deserve the best possible treatment and support we can provide for them.
- Someone at risk of suicide should be in the hospital.
While hospitalization may sometimes be necessary, it has not been demonstrated to be the most effective treatment for a suicidal crisis. In fact, people are at very high risk of dying just after being released from hospital. These transition times must be managed very carefully. Highly effective treatment for a suicidal crisis is available outside of a hospital setting.
- Teenager girls are at the greatest risk of suicide.
Sensationalized news coverage of young people's deaths can shape our perceptions of suicide. While suicide is the second leading cause of death for teenagers in Canada (motor vehicle accidents is the first), males are at four times greater risk of dying by suicide than females, and men age 50 and over are the people most at risk. Suicide affects people of all ages and genders.
- There's nothing I can do.
There are many ways to help people at risk of suicide survive and recover.
a) Blame and fight the disease, not the person the disease is attacking.
b) Encourage the person to keep trying treatments until she finds something effective.
c) Take any suicidal crisis seriously. Help the person at risk find the treatment and support he needs to stay alive.
d) Remind the person at risk that you care about her and that you want her to be alive. In randomized clinical trials, non-demanding demonstrations of care by others have been shown to reduce deaths.
e) If you are the person closest to the person at risk of suicide, don't assume medical and mental health professionals have expertise in treating suicidal crises, or will provide you with the information you need to be an effective support. Ask questions; advocate for the person at risk; don't be afraid to get involved.
f) Take a suicide first aid course like ASIST or safeTALK.
g) Take care of your own mental and physical health. If you're not healthy, your capacity to support others will be diminished.
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