Suicide remains a sad mystery in many ways. Those left behind can never really know what was in their loved one’s mind at the last. We blame ourselves, and we deal with all the guilt, anger and grief that the act leaves behind, but we can never completely understand what leads someone to take their own life.
Willa Goodfellow, in her blog Prozac Monologues takes issue with the notion of “suicide prevention”, as if non-suicidal people learning to recognize red flags of suicide and take action is the main way suicide is prevented. Those of us who are or have been suicidal know suicide prevention as a year-round, full time job. Those of us who are or have been suicidal have a whole lot of experience at preventing suicide. Is anyone interested to hear from us?
Goodfellow points out that it is not meaningful to address suicide as if it is “volitional” – a choice one makes at a particular time. Rather, suicide happens, she says, when pain exceeds resources for coping with pain. So if you are worrying about a friend or family member committing suicide, the most helpful thing is to find ways to reduce their pain – better access to health care, a friendly conversation, a bowl of hot soup, or even money, which can often ease pain in very effective ways.
Nonetheless, there are risk factors people can be aware of, and warning signs we can pay attention to. Just asking a friend or family member if they have thought about suicide can open up a non-judgmental conversation and give a real sense of connection to someone who may have felt isolated and alone in their thoughts before.
Some research has been done on the “steps” leading up to a suicide, and a few common factors have been identified. Thomas Joiner in his book Why people die by suicide identifies two beliefs that are often shared by people with suicidal thoughts. One is a sense of being a burden to others, or of not meeting expectations they believe others have of them. This can lead to a painful sense of self-loathing, and perceptions may be clouded at this point, especially in people suffering from anxiety or depression.
The second factor that Joiner identifies is a sense of “thwarted belongingness”, a feeling of loss of needed human connections, either because of death, conflict, or other separation. Thwarted belongingness leads to withdrawal from other social networks and a growing sense of aloneness and isolation.
Although many people may experience loneliness, grief or depression, most never contemplate suicide, let alone follow through. Joiner also identifies a set of factors he calls “acquired capacity”, meaning that the person is or becomes more familiar with the actual means of death, and that they become desensitized to violence and death.
“First, acquired capacity can come from a tendency towards natural risk-taking, such as those in law enforcement, thrill-seekers, or emergency department doctors. Second, acquired capacity can also be learned, often through painful and traumatic events, such as exposure to violence, abuse, life-threatening situations, repeated suicide attempts, injuries, and illness. The third involves how knowledgeable and comfortable an individual is with the lethal means to kill themselves, such as knowing how to fire a gun.”1
Even having acquired the capacity to commit suicide does not mean that a person will do so, but it does mean that they may have already overcome some of the fears that keep most people from following through.
Nancy
Reference:1 Parmar, Rashmi. Exploring Thoughts and Feelings Inside a Suicidal Mind. Psychiatric Times Sept.15, 2021.
The article also includes a useful list of Warning Signs, Risk Factors and Protective Factors, that we share here:
Warning Signs, Risk Factors, and Protective Factors
With warning signs, the risk of suicide is immediate or serious. Risk factors, on the other hand, increase the likelihood of suicide, but they are not an immediate symptom. Protective factors decrease the likelihood a person will commit suicide.
Warning Signs:
– Expressing the wish to die or wanting to kill oneself
– Talking about feeling hopeless, defeated, trapped, stuck, and having no purpose or meaning in life
– Speaking about being a burden on others or this world
– Feeling unbearable pain (emotional pain or physical pain)
– Searching for lethal methods online, like stockpiling pills or buying a gun
– Writing a goodbye note or bidding goodbye to family/close friends
– Giving up sentimental or prized personal items
– Sudden or abrupt changes in baselines, such as increased anger/agitation, poor frustration tolerance, increased anxiety, and reckless behavior
– Changes in sleep pattern, appetite
– Social isolation and withdrawn behavior
– Increased use of alcohol and/or illicit drugs
Major Risk Factors:
– Prior suicide attempt(s)
– Misuse and abuse of alcohol and/or drugs
– Mental disorders, particularly depression and other mood disorders
– Access to lethal means
– Knowing someone who died by suicide
– Family history of suicide
– Social isolation
– Chronic disease and disability, traumatic brain injury
– Lack of access to psychiatric care
– Perceived stigma toward mental illness
– Recent psychiatric hospitalization
– Other life stressors, such as the loss of a family member, work stress, and bullying
– Prior history of trauma or abuse
Protective Factors:
– Access to psychiatric care and a willingness to seek care
– Strong connections to family, friends, community, and social institutions
– Limited access to lethal means
– Life skills that include resilience in the face of adversity, problem-solving, coping, and adaptation to change
– Self-esteem and a sense of purpose or meaning in life – Cultural, religious, or personal beliefs that discourage suicide