On June 5 and June 8, 2018, respectively, fashion designer Kate Spade and food writer Anthony Bourdain committed suicide. They were but two of 120 people who end their lives this way on any given day. When a celebrity does something – for better or worse – it galvanizes conversation around whatever the issue happens to be, and when suicide is ushered to the forefront of public consciousness, it highlights the fragility of people – regardless of the size of their bank account, notoriety or social status. Suicide never discriminates.
Suicide rates have risen 30 percent since 1999, and suicide itself is a very complex phenomenon, which is beyond the scope of what I’m able to address in a single article. So, I’d rather focus on one element that virtually all suicides seem to have in common: Only human beings purposefully kill themselves.
Notwithstanding the vast volumes of literature on this subject, I’ve learned about suicide mostly from people I know from outside my professional life – as well as from those I’ve treated – who have experienced suicidal ideation and/or have attempted suicide. Uniformly, I was told that they were not trying to kill themselves per se, that is, their motive was not to end their life. Rather, they felt as though they were enveloped in a morass of overwhelming emotions and catastrophizing thoughts, leading to utter numbness and despair, and they needed to escape. As one friend of mine succinctly put it, “Joe, it’s not that I wanted to die, I just didn’t want to continue living the way I living was anymore.”
So what’s at the heart of this issue? Is there a central cause linked to suicide? That’s extremely unlikely, so I’m not about to tell you there is such a thing, and if you come across someone claiming to know, maintain a sense of healthy wariness.
Here’s what I believe to be a plausible construct: If our “sense of self” is positive, if our lives are reasonably structured and connected to some sense of purpose, and if we believe and feel we are liked – and even loved – suicide would seem unlikely. On the other hand, if the “sense of self” is decidedly negative, lacking even basic feelings of confidence, consumed with feelings of failure, a perceived inability to “fit in,” feeling lost, lacking direction and experiencing profound loneliness accompanied by emotional withdrawal and social isolation, suicide enters the realm of possibility.
Then there is the practical issue of earning a suitable living as well as the more subtle pressure of succeeding – personally, professionally and socially. The inability to meet these demands, whether perceived or real, then gives rise to anxiety and intense worry, and if fueled by substance abuse, create a downward and descending spiral – weakening self-confidence while strengthening feelings of failure and self-loathing.
For too long when treating depressed or extremely anxious clients, I relied on external symptoms, such as lack of energy, low motivation and sleeplessness to guide my treatment decisions. Not until it struck me that so many of my depressed patients were mired in the throes of often profoundly low self-esteem and extremely poor self-image, did I change my treatment strategy toward focusing instead on the client’s internal emotions. I started urging my patients to just “tell me their story.” I discovered the sea of negativity they had been swimming in for years on end in some cases. I discovered they felt themselves to be incompetent failures and how their day-to-day lives were dominated by grossly unpleasant memories of the past and fears of the future. I discovered that thoughts of suicide and even planning an attempt had been in the works, and realized I hadn’t necessarily asked about this. I then understood that these factors were the precursors to the depression they were feeling and that I had better address these issues first – as they were the subtext of what these people’s lives had become.
As therapists and counselors, we should routinely have open conversations about suicide where applicable, and shouldn’t be reticent about initiating the dialogue. We are trained to know that asking if someone is suicidal is unlikely to increase ideation, and may actually decrease it. Here’s how I approach it: “Are you having any life-threatening or life-ending thoughts or plans that we should talk about?”
If you don’t have mental health training and are faced with a loved one contemplating suicide, the task of initiating a potentially challenging and emotionally fraught conversation can be daunting. So do a little research and have some resources at hand when you speak. A good place to start is by providing the number for the Suicide Prevention Lifeline (1-800-273-TALK). And remember that in some cases, your support can only go so far. Just like us, they’ll act in their own time when they’re ready.
Right now, someone we know is struggling with something we know nothing about. Suicidal ideation or tendencies can impact anyone, and even respectable public faces can camouflage unspoken private pain.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.