Published in The Doctor Weighs In, September 10, 2019. View the Article Here
If we want to reverse the growing trend of suicide in America, we have to take a hard look at the underlying causes, including links to the addiction crisis
Suicide deaths increased by 31% in America between 2001 and 2017. The concerns and perils surrounding suicide in the United States continue to grow as more people are attempting and committing suicide than ever before. It is important that we examine the underlying reasons that are fueling this increase, including links to the addiction crisis.
The national conversation surrounding suicide has become more and more prevalent in the past few years. This is especially true with popular Netflix shows like “13 Reasons Why” entering into the mainstream debate about how we view, discuss, and address this devastating issue.
However, the problem as I see it is that people are generally more worried about how suicide is depicted and discussed. And, unfortunately, they are less concerned with why it’s becoming a more prevalent issue in the first place.
Understanding the what and why of suicide in America
When someone commits suicide, they leave a void of grief in every person that was part of their life. Naturally, this topic is hard to have a balanced discussion about because the nagging question of “why?” is too hard emotionally to answer in an objective manner. However, if we want to reverse the growing trend of suicide in America, we must take a hard look at the underlying causes, such as mental health and addiction:
The probability of suicidal ideation, attempts, and death increases with a mental health diagnosis, such as anxiety and depression.
The probability of suicide also increases significantly for those who suffer from severe substance use disorder or addiction.
Familiarity with each of the following issues is crucial in decreasing overall suicide rates:
Some suicide stats
According to the American Foundation for Suicide Prevention (AFSP, 2017), almost 50,000 people died of suicide in the United States in 2017.This translates into ~129 suicides per day.
We also know that:
Something must be done. I believe that an excellent first step is a thorough understanding of the problem.
Dissecting the definition of suicide
For many people, it is hard to understand how someone arrives at a point in life where suicide becomes an option. To some, it may seem redundant to break down the definition of what suicide actually is. However, because this issue is so emotionally charged it is imperative to look at this problem from as clinical a perspective as possible.
The National Institute of Health (NIH) defines suicide as
“death caused by self-directed injurious behavior with the intent to die as a result of the behavior” (NIH).
Self-directed implies that a person’s death is under their control and on their terms. This may seem like the case for some. However, an argument can certainly be made that those who suffer from a major mental health issue or severe substance use disorder have impaired decision-making abilities.
In the case of a mental health diagnosis, the impairment could be caused by a dangerous dip in an individual’s depression. For someone suffering from addiction, the structural and functional changes in the brain may have something to do with seeing death as the only or best choice. Rationally we know that this is not the case, but in the darkness of mental health issues and addiction, suicide may be the only path that someone can see.
The mental state of a suicidal individual
David Foster Wallace was a profound American author who struggled with depression and mental health issues his entire life. Though he wasn’t a medical expert, in the book ‘Infinite Jest’, he poignantly described the mental condition experienced by those contemplating or attempting suicide:
“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing.
The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise.
Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant.
The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames.
And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
What we can learn from those who attempt suicide?
Tragically, David Foster Wallace eventually committed suicide himself. I suggest we review his own experience of this condition through his fictional work. That is because we can learn so much by examining this issue from the perspective of those who contemplate or attempt suicide. We can rest assured there is more than just a self-directed desire for death that brings someone to the precipice of a suicide attempt.
It is important to note that not all suicide attempts result in suicide.A suicide attempt “is a non-fatal, directed, potentially injurious behavior with the intent to die as a result of the behavior (NIH).”
In 2017, it is estimated that within the United States a staggering 1,400,000 suicide attempts were made (Centers for Disease Control and Prevention, 2017 ; American Foundation for Suicide Prevention). Past suicide attempts are the biggest predictive factor as to whether someone will eventually die by suicide. Thus, past suicide attempts may be key in helping us to intervene before a devastating death does occur.
Psychological pain: a key factor in suicide attempts and death
Both environmental and psychological factors are important to acknowledge when discussing suicide. Yuodelis-Flores and Ries (2015), in their review of the literature exploring the connection between addiction and suicide, outline the many risk factors associated with suicide including
Pain from the environment including the pain associated with relationship break-ups and past and current sexual trauma is important to be aware of and to ask about when working with individuals and families in medical and mental health settings.
In addition to the pain that relationship disruption can cause, how an individual copes and manages interpersonal stressors can help to identify people who may be at an increased risk.Such pain from both the environment as well as how someone copes with the pain can create the context by which someone pursues substances to manage and handle the associated stress.
For many, initial substance use can progress and morph into a substance use problem.This vicious cycle increases the likelihood of suicide.
Those who suffer from a co-occurring substance use disorder and mental health disorder may be experiencing a potentially treacherous pathway toward suicide.Major depression, anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), and personality disorders can all create an increased risk for suicide attempts and suicide completion (Yuodelis-Flores and Ries, 2015).
Suicide in America: Links to the addiction crisis
Suicide is the #1 cause of death for those who have a substance use disorder (Wilcox, Conner, & Caine, 2004; SAMSHA TIP #50) . For those who meet the criteria for severe substance use disorder they are at an even more elevated risk to commit suicide (SAMSHA TIP #50)
Researchers have estimated that having an alcohol use disorder increases a person’s risk of suicide 8-10-fold over standard suicide death ratios (Flensburg-Madsen, 2009 ; Wilcox, Conner, & Caine, 2004).Researchers have also found that as many as 40% of people who struggle with severe alcohol use disorder have attempted suicide an average of 2.44 times (Roy and Janal, 2007; Yuodelis-Flores and Ries, 2015)
What can be done to prevent suicide?
We cannot sit idly by and watch as more and more people we love attempt and succeed in taking their own life.We must do all that we can within our own families, communities, and organizations to prevent and to assist those who suffer.Here are some concrete action steps:
1. Know the factors that increase risk
Previously, we discussed the factors that increase the risk for someone to commit suicide.Educate yourself about these factors so that you are aware, and then educate others.Remember that those with previous attempts are at most risk for future suicidal behavior.
2. Educate yourself
There are several different organizations that offer training on suicide prevention. For example, the American Foundation for Suicide Prevention (AFSP) offers many different useful and free trainings for everyone. They can be accessed at this website.
Such training can assist us in not only gaining knowledge but also give us the courage to have meaningful conversations about suicide with those around us. These conversations may lead to suicide prevention and needed help.
3. Become an advocate
You can work to become an advocate in your community to bring awareness to suicide and to assist in preventing suicide. Information about becoming a community advocate can be found at the American Foundation for Suicide Preventions website.More and more advocates are needed every day.
4. Know the warning signs
The American Psychological Association (APA) lists on their website several different warning signs related to suicide. Everyone needs to know and recognize the warning signs and to be ready to act. Some of these signs include previous attempts, talking about committing suicide, changes in behavior and mood, isolating, making final arrangements, and giving away prized belongings. This is not an exhaustive list and more warning signs can be found at the APA website as well as the AFSP website.
5. Reach out for help quickly
If you are feeling suicidal or you feel like someone you know and love is suicidal, reach out for help quickly. It may not feel like you have a choice, but there is always an alternative to suicide. A great resource to have on hand is the National Suicide Prevention Lifeline which you can reach by calling 1-800-273-TALK (8255) 24 hours a day, 7 days a week. Also, remember that first responders are always available at 911.
Suicide: An individual action with a collective solution
When someone commits suicide it leaves a crater-sized hole in the hearts and lives of everyone around them. The devastation of suicide impacts families, communities, and our nation. But, this is not an issue that we can or should expect suicidal individuals to solve alone.
Just like with any mental health condition or addiction, individuals who are suicidal require a whole network of people that are vigilant about helping them recover from this mental state. That requires a collective effort to understand who could be at risk for suicide. And, how we can contribute to the solution of reducing suicide attempts and death rates.
Those at most risk are those who have been hurt by sexual abuse, those with mental health disorders, and those who suffer from severe substance use disorders/addictions.
We can do much for the cause of preventing suicide including knowing the risk factors and warning signs, educating ourselves about prevention, becoming an advocate, as well as knowing how to reach out for help.Together we can instill hope in others and help others to move forward toward meaningful help and healing.
The bottom line
As a country, we have a responsibility to change the way we address and think about the issue of suicidal thoughts and behaviors so that individuals do not feel ashamed to admit they might be experiencing this incredibly difficult mental struggle. We must change our mentality and actions to solve this growing national problem. If we do not, we are consigning many of our friends and family members to suffer and possibly die in silence.
Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2017. Suicide rates listed are Age-Adjusted Rates.
Flensborg-Madsen, T., Knop, J. Lykke Mortensen, E., Becker, U., Sher, L. & Grønbæk, M. (2009). Alcohol use disorders increase the risk of completed suicide — Irrespective of other psychiatric disorders. A longitudinal cohort study, Psychiatry Research, Volume 167, Issues 1–2, 123-130, ISSN 0165-1781.
Wilcox, H., Conner, H., & Caine, E. (2004). Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies, Drug and Alcohol Dependence, Volume 76, Supplement, S11-S19. ISSN 0376-8716,