Suicide

Introduction. Talking about suicide is not easy. There are still taboos and lack of information around this topic.

Numerous people have had negative thoughts at some point in their lives. There is no need to feel ashamed when saying that there have been times when we may have found it hard to cope and we have thought about the possibility of ending our life as a way out. Suicidal thoughts are not uncommon. They are usually fleeting and go away by theirselves or as soon as social circumstances change.

There are some other cases in which people experience fixed negative thoughts and they start thinking about possible plans of ending their life and how to act them. This usually happens in the context of major mental disorders, such as Depression, Bipolar Disorder, Schizoaffective Disorder, Schizophrenia and other Psychotic Disorders. It can also happen when life stressors, such as financial worries, social isolation, divorce, and homelessness, become too much and bring to a point where it is difficult to see a way to overcome them. In the vast majority of cases a combination of mental illness and life events is usually responsible for suicidal thoughts, plans and intent. Furthermore, in some cases people try to self-medicate by using alcohol and/or substances. This increases the likelihood of impulsive acts and causes further deterioration in mental state, which are both related to an increase suicide risk.

 

Definition. Suicide is defined as the act of taking one’s own life voluntarily and intentionally. There is not much more information on a dictionary. It is difficult to explain and describe how someone who attempts/commits suicide feels.

Suicide is an act of extreme despair that is carried out when people feel helpless, worthless and hopeless. The first image that comes into my mind is the one of a black blanket that surrounds us and does not let us breathe properly. We cannot see much behind the blanket because it covers everything. The blanket becomes everything. It prevents us from moving forward and makes us feel stuck. It is also the reason why we cannot see a way out. The same reason there is only an ending and no beginning. It is at this stage that it is fundamentally important to share how we feel with family members, carers and professionals. We would all agree that death is death, and there is no coming back. Making the decision of not ending our life give us a second chance. A change of getting help even though we are not really sure anything will change the way things are. It’s okay and worth to ask for help.

 

What do I do if I feel suicidal? Feeling suicidal and dealing with mental health problems can be difficult, but there are places to access professional support and get help.

If you are feeling like attempting suicide in the immediate future, it is utterly important to dial 999 or go to A&E where you can get prompt professional help. Suicidal thoughts and plans are a medical emergency that can be successfully treated by professionals.

If the thoughts are not persistent and you feel you can cope, the most important step is to urgently discuss how you feel with your GP and if possible with family members, friends and carers. Your GP may wish to refer you to Mental Health Services in order for you to get specialised support and treatment.

Remember that even if everything looks dark and you cannot see any way your current situation can improve, it will go away if you ask for help. The way you feel is driven by an illness, which can and needs treatment. When you think about killing yourself just reflect on the fact that there is no turning back from death and it is worth to give life a second chance.

Below that are some emergency numbers:

Ambulance: 999 (UK)

                       911 (United States of America and Canada)

                       000 (Australia)

                       112 only from mobile phone (Australia)

                       106 for people that have hearing or speech impairment (Australia)

Helplines:

Samaritans: 116 123 for everyone 24 hours 7 days a week (UK and Republic of Ireland)

Campaign against living miserably: 0800 58 58 58 for men from 5pm to midnight everyday (UK)

Papyrus: 0800 068 41 41 for people under 35 Monday to Friday from 10am to 10pm, weekends from 2pm to 10pm, Bank Holidays from 2pm to 5 pm. (UK)

Childline: 0800 1111 for children and young people under 19 (UK)

The Silver Line: 0800 470 80 90 for older people (UK)

Suicide Prevention and Crisis Hotline: 1 (800) 273 – 8255 (United States of America)

National Suicide Prevention Lifeline: 1 (800) 273 – 8255 (United States of America)

Suicide Hotline: 1 (800) 784 – 2433 (United States of America)

Lifeline Australia: 13 11 14 for everyone 24 hours 7 days a week (Australia)

The Samaritans: free Countryline 1800 198 313, Hotline 08 93 82 8822 for everyone 24 hours 7 days a week (Australia)

 

Suicide throughout history. Throughout history, suicide has been both condemned and accepted by various societies. It has been condemned by Islam, Judaism, and Christianity.

In Ancient Greece, suicide was generally regarded as not wrong in itself. However, a clear justification needed to be identified.

In Ancient Rome, there was no prohibition of suicide for citizens. On the other side, especially towards the end of the Empire, suicide became forbidden for slaves. This was due to the high incidence of suicide among slaves that deprived their owners of a valuable property. Because life was not considered as a gift of the gods, most Romans supported the idea of suicide in certain specific situations, such as individuals preferring death to dishonour or people wishing to avoid the decrepitude of old age.

In the Middle Ages, suicide was often considered the result of diabolical temptation induced by despair or madness. Penalties used to be inflicted on the dead body – such as dragging it through the streets where the deceased had lived and hanging it. The estates of these people were confiscated, and Christian burial was forbidden.

Attitudes towards suicide began to change slowly during the Renaissance, although for many religious people suicide was still regarded as diabolical.

In the 19th Century, in England, coroners’ juries began indicating that an individual was only insane at the actual moment of suicide. And, among the aristocracy, some suicides started being attributed to accidents. In this century, the religious penalties for suicide were finally abandoned.

Across Europe, suicide was slowly decriminalised, although it was not until 1961 that the Suicide Act was finally adopted in England and Wales with the removal of penalties.

 

Risk factors. Since the 1930s, there have been several research studies, books and conferences about suicide. The aim is to increase the awareness on this topic for patients, carers, and professionals. There is not a single approach that can be expected to succeed in reducing the incidence of suicide. However, early recognition and treatment of mental disorders is an important deterrent.

It is fundamental to highlight and describe the following factors that increase the risk of suicide:

  • Male gender;
  • Older age. Even though it is documented that men in the UK aged between 20 and 49 are more likely to die from suicide than any other cause of death;
  • Loss of family support and deterioration in personal relationships;
  • Separated/widowed/divorced;
  • Loss of accommodation or unstable living arrangements;
  • Unemployed/retired;
  • Previous history of suicidal attempts;
  • Previous use of violent methods;
  • Misuse of drugs and/or alcohol;
  • Major psychiatric diagnosis such as Severe Depressive Illness, Bipolar Disorder, Schizophrenia, Schizoaffective Disorder, Chronic Sleep Disorders;
  • Symptoms such as: pessimism, inability to feel pleasure in normally pleasurable activities, despair, morbid guilt, insomnia, self neglect, memory impairment, agitation, and panic attacks;
  • Expressing suicidal ideas;
  • Expressing intent to harm to self;
  • Plans of self harm;
  • Belief to have no control over their life;
  • Expressing high levels of distress;
  • Family history of suicide;
  • Helplessness or hopelessness;
  • Recent significant life events;
  • Major physical illness and/or disability.

 

How do I know if my loved one is suicidal? There are some key suicide warning signs that people in distress can display.  Someone who is thinking about suicide will usually give some clues to those around them that show they are troubled. Suicide prevention starts with recognising these warning signs and treating them seriously.

People often present with clinical signs of Depression. They may look sad, dishevelled and tired. They may talk about the fact that they have not been sleeping or eating well or on the contrary they have been eating and sleeping too much. They may say they have lost interest in activities they were previously interested in and they have lost interest in sex. They may express feelings of hopelessness, worthlessness and powerlessness. They may feel lonely and/or tend to isolate theirselves. We could also notice that they have an increase in minor illnesses such as dermatological illnesses (eczema, herpes simplex, psoriasis), gastroenterological symptoms or chronic pain.

An alarm bell needs to ring in our mind when we hear phrases such as “What’s the point? Things are never going to get any better”; “It’s all my fault. I’m to blame”; “I can’t take this anymore”; “I’m on my own. No one cares about me”; “I’ve been irreparably damaged. I’ll never be the same again”; “Nothing I do makes a bit of difference. It’s beyond my control”.

From a behavioural point of you, what we notice is that people withdraw from family and friends, they look anxious and agitated, they cry inexplicably, they quit activities that they used to enjoy, they put affairs in order, and they write unusual good-bye messages or letters.

For some reasons, there are people that believe that if a person says they want to commit suicide it means it is not the case. Wrong. Declared intent to kill themselves is the strongest indicator of risk and should never be dismissed.

 

How can I help someone who is suicidal? Talking to a friend or family member about their suicidal thoughts can be extremely difficult. But if you are unsure whether someone is suicidal, the best way to find out is to ask.

You might be worried that you could put the idea of suicide into the person’s head if you ask about suicide. However, it is good to know that you cannot make a person suicidal by showing your concern. In fact, giving a suicidal person the opportunity to express their feelings can give relief from isolation and may reduce the risk of a suicide attempt.

If someone you know tells you that he or she is thinking about suicide, it is vital to evaluate the risk. People who are at the highest risk in the immediate future have the intention to end their life, a specific plan, the means to carry out the plan and a time frame. It may appear obvious but is important for both professionals and non to explore if the person sees suicide as a solution to his or her problems. Questions like these could help in estimating the risk:

  • Does the person think or fantasise about suicide?
  • How frequently does the person think about suicide and how does he or she respond to these thoughts?

The greater the prominence and rigidity of these thoughts in the person’s life, the higher the risk of suicide. Fleeting thoughts quickly rejected represent low risk, while persistent, intrusive and painful thoughts indicate high risk even in the absence of planning. Protective factors from suicide can be religious beliefs or family obligations. If the person admits suicidal ideas, we need to explore if he or she has taken it a stage further to commence planning how to do it and how likely is the plan to succeed. Preparation, including hoarding of tablets, settling financial affairs or leaving a note, or both are indicators of a high risk.

If we find out that an individual is presenting with high suicide risk, it is advisable to encourage the person to attend A&E or we may want to call an ambulance. If the risk is not imminent we may suggest that the person attends the GP Surgery and if possible, we accompany them.  People that are suicidal need help and support. It is important to make sure we are there for them.

Image by Nicoletta Ceccoli

Depression

Depression is a mental disorder characterised by some very specific core symptoms. Unfortunately, nowadays, there are still people that think Depression is not a real illness but a sign of weakness or something that can be sorted out by the individual if she/he really wants. They are terribly wrong. Depression is a psychiatric illness with defined and well-known symptoms.

Depression affects people of every age and can happen to anyone. Many successful and famous people battle with this problem every day. Living with Depression is difficult for those who suffer from it as well as for their family, friends and colleagues.

 

What does depression feel like?

Depression affects people in different ways and causes a wide range of symptoms. In a Depressive Episode people may experience: persistent low mood; diminished interest or pleasure in activities; low energy; feeling of worthless or guilt; low self confidence; diminished ability to think or concentrate; agitation or slowing of movement; poor or increased appetite; poor or increased sleep; suicidal thoughts or acts. Symptoms of depression range from mild to severe, depending on the number of symptoms present and on their intensity.

 

When should I seek help for depression?  Suffering from clinical depression is different from feeling low in mood or sad. In fact, feeling sad from time to time is a common experience for human beings and does not require specialist input. When your mood is persistently low, you think that life is not worth or there are other symptoms that make it difficult to cope with your daily activities, it is important to discuss it with your family members, GP, and Psychiatrist. There are people that usually wait before seeking help for Depression, however it is best not to delay. Asking for help and support if the first step to recovery.

 

Why did I get depressed? There is not a single cause of Depression. Many factors are deemed to be responsible. Depression has been linked to an imbalance of neurotransmitters in the brain, such as Serotonin, Norepinephrine, and Dopamine. The use of neuroimaging has shown which brain regions regulate mood and how other functions, such as memory, may be affected by Depression. Areas in our brain that play a significant role in Depression are Amygdala, Thalamus, and Hippocampus. Researches showed that the Hippocampus is smaller in some depressed people.

Stressful life events, such as bereavement, divorce, illness, financial worries, unemployment, can have an important role in the emerge of Depression. At the same time some personality traits, such as being overly self-critical or having low self-esteem, can make people more vulnerable to develop Depression.

Having family members that have suffered from Depression increases the risk of developing the same illness. However, due to the fact that Depression is a result of several concomitant factors, genetic predisposition cannot be considered the only cause. Also social isolation plays an important role in the genesis of Depression, which shows the importance of having support from family and/or friends. Some women are particularly vulnerable to Depression after pregnancy. The hormonal and physical changes, as well as the added responsibility of a new life, can lead to what is called Post-natal Depression.

When life is getting people down, some individuals try to cope by drinking alcohol or taking drugs. This can result in a spiral of depression.

A higher risk of Depression has been seen in longstanding or life threatening illnesses, such as cancer, coronary heart disease, head injury and chronic pain.

 

Treatment. Treatment for Depression can involve a combination of lifestyle changes, psychological therapies and medical treatment.

Medication is not the first choice if Depression is mild. In this case, it may be worth considering life style changes and psychological sessions.

Medical treatment is used for moderate and severe Clinical Depression. Antidepressants are a type of medication used to treat Depression. They work by increasing the levels of neurotransmitters, such as Serotonin and Noradrenaline, in the brain.

Antidepressant medications are a first line treatment for Major Depressive Disorder and for sub-threshold Depression that has persisted for 2 years or more. Antidepressants are an option for short duration Major Depressive Disorder if there is a history of moderate to severe depressive episodes or if Depression has persisted for more than 2-3 months.

Antidepressants usually exist in tablet form. When prescribed, the medication is started at the lowest dose possible and it takes about 2-3 weeks before the benefits are felt. It is very important to take the medication consistently, every day, and not to stop it if you experience mild side effects. These can be easily discussed with your specialist and are mostly temporary. A course of treatment lasts at least six months.

 

Caring for someone with Depression.  The support of friends and family can play a very important role in someone who is suffering from Depression. The best thing that relatives and family members can do is to simply listen, which makes people feel less lonely and isolated.

It is important to support the people we love to get medical help and be open about Depression. It might be hard for the people we love to have the energy to keep up contact, so carers may want to try to maintain in touch.

Caring for someone suffering from Depression is not an easy task and can be overwhelming at times. Therefore, it is always important that carers keep a balance in their life and maintain some spare time in order to look after theirselves. Carers that feel burnt out are encouraged to talk to their GP and find out if there is support they can access, such as counselling, family therapy or carers’ support network.

 

 

 

illustration by Benjamin Lacombe