Can you think of a touchier subject than suicide?
Religion? Politics? Race? An old man’s range of interesting skin diseases? It’s up there on the dinner party list of things not to say under any circumstances. But we don’t mention it in the same way – “don’t talk about religion or politics in polite conversation” (let’s leave the skin diseases for now) – because as a society we try and ignore it, push it out of our minds. It’s not something nice people do, is it?
Shhh! Nice people don't behave like that!
But I want to talk about suicide here. Now I may be preaching to the converted here, as lot of the readership of this blog have had experiences with suicide. However, it’s a growing problem which needs to be talked about within so-called “polite society”. It’s a much bigger problem than most people dare to imagine. Every 40 seconds someone tops themselves. Following RTCs, suicide is the biggest killer of 16-24 year olds, that key age-group that we really need to keep alive if only to support the growing number of ill and retired 
Suicide, and mental health in general, is slowly sneaking it’s way into the public eye. Remember the 1 in 4 campaign? Time To Change? The work of Rethink? But leaving aside the wider topic of mental health, do we really understand why people try to, and succeed in, killing themselves? Awareness is all well and good, but how can we try and change things if we don’t have the foggiest to the underlying mechanism?
Which is why I had such high hopes when I spotted in my RSS feeds this article: Why do some people kill themselves?
Suicide has always been a conundrum for psychologists and other researchers interested in human behaviour. Self-preservation is one of the strongest human instincts, so the drive to commit suicide must be even more powerful. But what causes it? … More recent explanations have tended to focus on factors such as depression, hopelessness and emotional pain, but none of them have had much success in answering the fundamental question about suicide: why do some people kill themselves while others in seemingly identical circumstances do not? (New Scientist)
The article centres around research into anorexia and Thomas Joiner’s attempt to design a “grand theory of suicide”. But does it really tell us anything we don’t already know? The key points regarding someone who commits suicide:
- They feel depressed and hopeless at the time. In many, this is due to a mental health condition.
- They have a serious desire to die. They may feel like a burden on others, yet isolated.
- They must be capable of doing it – overcoming the self-preservation instinct.
The final point is the “groundbreaking” part of the work. It’s something so obvious yet missed, I know at least by me, when considering suicide. Not capable as in the means, but capable of overcoming something hard-wired into any animal’s brain eons ago, that dying is a bad thing for a body. And importantly, it’s something we as carers for someone who wants to kill themselves, or even as people who know that at somepoint soon the dark cloud will descend, can work at changing.
How does one overcome this instinct then? Two methods are suggested. Firstly, there’s essentially desensitisation – “building up” to the, for want of a better word, killer blow with smaller overdoses, self harm events, cry’s for help. I’m not sure I’m a fan of this idea, mostly because it trivialises unsuccessful genuine suicide attempts and ranks them alongside the SLG behaviour after a couple of Lambrinis and an argument with boyfriend-of-the-week. But it may have some milage, if we look at overcoming this instinct in a similar way to overcoming the bodies response to any noxious stimuli, causing pain to an area can numb the pain in the future.
The second is similar yet different. One becomes accustomed to painful or scary experiences, for example soldiers, police offices, doctors, all of whom have higher than normal suicide rate. Joiner describes this as a “steeliness” in the face of things that would intimidate most people.
Canonical "mental steeliness" - soldiers and PTSD
Here’s where the anorexia link comes in, as a way to discriminating between the two hypothesis. People who suffer from anorexia are more likely to die from suicide than the “average” member of society. Sad but true. So according to the theory outlined above, either anorexia sufferers have weakened their body in such a way that a normal suicide attempt rate leads to more successes, or they’re psychologically inured to pain so they’re more capable of doing what is necessary.
Turns out that, for at least the small sample looked at, it’s the latter. The suicides were done in such a way that the physical frailty of the body was of no consequence, the technique used would have killed anyone regardless of how fit and well their body was. The reason that so many anorexia sufferers die isn’t because their body is easy to kill, but because their brain is.
So let’s go back to the three apparently simple bullet points (bad turn of phrase) for assessing the person who commits suicide. They’re depressed; tick. The desire to die is there – the illness itself leads to isolation (think of how much social behaviour is centred around eating and drinking?) and the sense of being a burden on those worried about you, forcing you to eat; tick. And finally, the mental strength to be capable of doing it, not only due to the physical pain inflicted on the body by starvation and malnutrition but also the psychological pain that eventually means that the body’s self preservation is weakened or all-together packed up and gone; tick. The same thing is seen in bulimia sufferers, with the same proposed mechanism.
In answering my original question, is the article telling us anything we don’t already know, I’d utter a surprised yes. The whole thing looked so simple at first glance, another science watered down for the idiot New Scientist affair, but looking deeper into it the whole idea of overcoming that self-preservation instinct is one of those “d’oh!” moments – so obvious that everyone has missed it.
What does this mean? Well, as Joiner himself says at the end of the article, it’s still just an idea that needs more work.
“It’s a start,” he says of the evidence assembled to date. “But we need something much more systematic.”
But as a concept, it makes sense, and as such is something we can start to address right away as both friends and carers of the suicidal, and as those who know that at some point that dark cloud is going to descend whether we like it or not.
A lot of suicide prevention is concentrated on the first two points. We try and stop people feeling depressed by any method from the well-intentioned yet poorly thought out, “yeah, but at least you’re not as bad as those poor starving kids in Africa”. or even worse, “pull yourself together”, to pharmacological means to counseling or talking therapy. And we attempt to address that desire to commit suicide, by trying to involved the depressed person in life more and to make it clear that they really aren’t a burden, we just care about them.
But do we ever think to address that capability to commit suicide? We try in a way, removing the physical objects used, the knives and medications, but I don’t think we ever consciously look at the person’s mental state and how that allows them to successfully commit suicide.
Can we do that? As is always the answer, we can talk to the depressed person. Try and overcome this psychological “strength” – I know I could do with someone to just sit and listen to me rant about all the things in my job and in my personal life that “steel” me against the outside world, that make me bring down the mental shutters and turn into one of those PTSD-like “survivors” who have the mental resolve to overcome the body’s want to stay alive because we’ve already seen too much. Being less narcissistic, I can several people immediately spring to mind who could do with a good rant in the same way. And now I’m thinking beyond that superficial, and how this could help others who are inured to psychological pain in deeper ways…
But then it comes down to how good a talker you are (or I guess more importantly, listener and reacter you are), and we go straight back to that “silver bullet” of mental health – appropriate therapy.
So my conclusion seems to be more therapy is needed. Perhaps I should go work for NICE?
Posted by nickopotamus 
Posted by nickopotamus 
Posted by nickopotamus 
