Out of the Darkness - Suicide Prevention

Today on the blog, I have a very special guest. My brother, Alan Oates, is here to talk about the very difficult subjects of suicide and suicide prevention. The post is long, but a worthwhile read.

“In sooth I know not why I am so sad. It wearies me, you say it wearies you; But how I caught it, found it, or came by it, What stuff ‘tis made of, where of it is born, I am to learn And such a want-wit sadness makes of me That I have much ado to know myself”

~The Merchant of Venice

Having being asked to write a blog on suicide by my sister, I suddenly realised that I would need to contemplate a subject that most of us push to the furthest recesses of our mind. In fact, one of the greatest tragedies of suicide is the fact that it’s so utterly painful to deal with, that we never really look at it with an open mind and heart. The result of this is that we don’t examine a subject that literally means life or death for a lot of us. Albert Camus once famously noted that “judging whether life is or is not worth living amounts to answering the fundamental question of philosophy”. Asking the hard questions and exploring the issue is the only way we can begin to understand one of the most truly agonising situation that may occur in a person’s life and the effect it has on those around them. Like Antonio above in The Merchant of Venice; we may not understand how or why we feel the way we do, but we must look deep into ourselves if we are to truly know this sadness.
Firstly I will look at some hard and fast facts about suicide to highlight the significance and extent of this issue.
Definition:
Suicide is the result of an act deliberately initiated and performed by a person in the full knowledge or expectation of its fatal outcome.

• Every 40 seconds someone commits suicide somewhere in the world
• Every 3 seconds, someone tries to die
• Is among the top 3 causes of death in 15-30 year olds and the number 1 cause of death in males of this age group in Ireland
• Suicide is the forth cause of potential life lost among men in Ireland, superseded only by circulatory disease, cancer and respiratory disease
• Suicide peaks again for those over 75 years of age
• Suicide was a criminal offence in Ireland until 1993.
• More men commit suicide than women, but more women attempt suicide
• Suicide is associated with moderate rather than sever forms of depression

My intention here is to give anyone who reads this some insight into the gravity of the situation. This is a wide spread issue, encapsulating all areas of society, not a matter of debate and discourse but this actually means lives lost every few sounds of the day. Suicide affects all those involved and due to its predominant nature in today’s society, very few people have been left untouched by this. While writing this I remember a close friend of mine who died by suicide four years ago, his memory helps remind me of the human nature of this issue and not to fall into statistics and detached language.
When we think that it is the leading cause of life lost among men in Ireland between the ages of 15-30 we can see the gravity of the situation. Imagine if this was a coronary disease that we were talking about; how much money would be allocated for research to combat it? This percentage is only rising and we can’t afford to be complacent. Again, these are people’s lives that we are talking about.
On a side note, I realise there are a number of issues that come to the fore when suicide is mentioned; that of euthanasia and that by highlighting or talking about suicide we only increase the likelihood of suicide becoming a viable option. When I speak here, I am referring to the definition of suicide itself. As such any form of deliberately initiated acts, aimed to towards death. I’m not going to speak independently about assisted death or people who have chosen death as a quality of life decision. I believe that it’s not my place to judge the actions of another human being and whether it’s right or wrong isn’t a decision that I make. When I talk of suicide I speak of the truly earth shattering pain that someone goes through and their need to end this suffering. When people try to kill themselves they might not want to end their life, but they may hope to end the pain they are experiencing. If we might help another person find a way to escape their pain and live a happier more fulfilling life then we can share a moment like no other—A gift of life.
The idea that speaking about suicide and publishing awareness information increases the risk of suicide behaviour has been debated for a number of years. There have been studies suggesting that the suicide of influential figures increases the propensity for there followers to do the same {see Media Contagion and Suicide Among the Young}. Added to this fact studies carried out in Germany have shown that during a suicide awareness campaign suicide increased on a popular railroad known for suicide attempts by 175%! We're learning that a suicide can go viral quickly with "memorial" posts, which may lead to other youth considering it as an option. It’s quite reasonable to presume that, psychologically speaking, the common thread here is the glorification of suicide as viable options to achieve notary, as well as the sustaining the belief that it is a positive response to life difficult issues. However, we must be very aware that we can’t be burry are heads in the sand; not to talk about this issue is far more dangerous than sweeping the issue under the rug.

• If suicide prevention advocates help and educates the Media about suicide prevention, you can raise awareness about both the problem and the solutions.
• With more people reading and talking publicly about suicide and mental illness, you can eliminate the stigma that keeps so many people from seeking the treatment they need
• In the long term, increased awareness and understanding of the value of treatment will build support for mental health parity

As this is an important topic, here is a relevant link discussing how to report suicide in the media http://www.sprc.org/sites/sprc.org/files/library/media_guide.pdf
Working as psychotherapist I come into contact with a number of people who have thought about suicide. One important thing to remember is that 30% try again with no therapy and 16% with therapy. The importance and value of talking about our suffering can’t be underestimated. Furthermore, it has been shown that a concerned party asking someone if they are thinking about suicide does not increase the likelihood of that person contemplating suicide. If you fear your loved one is hurting, ask them about it, an ear to listen and a shoulder to cry on may be two of the most powerful tools we have against suicide and they are ready available all we need to do is use them.

• Take their expression of wanting to die seriously
• When a person expresses a wish to die believe them and accept the pain they feel
• Ask if they feel suicidal

In one of my points above I spoke about suicide being associated with more moderate levels of depression. This is a very important issue to talk about as some people believe because there love one is no longer as painfully sad as they were before; the risk is no longer there. This can be a dangerous belief, as it’s been shown that in the first 5 to 8 weeks after the symptoms of depression lift that the highest risk factor for suicide exists. This is because the person may not have had the strength to even attempt the action while in the throws of depression, or possibly seem calmer as they have become resigned to the fact that they intend to kill themselves. It’s even noted that a lack of any emotional affect can be a sign of depression leading to suicide. Again, we must not think that because the person does not seem to be hurting on the outside that they haven’t got deep scares that run much further than our eyes can see.
We don’t need to be experts on the subject to intervene, what we need to do is offer some compassion. There are professionals out there who offer a service that can help people deal with their feelings and thoughts that may lead to suicide. There are doctors, therapist, counsellors, listening services and online counselling, to name but a few. The idea is to keep them alive long enough for them to begin the healing process and to find some extra support systems. I like to think of this like an emergency tourniquet, if the person is in immediate danger they may not be able to stop their trauma by themselves, but if we can offer an emergency response before getting further help, the person that does this will literally be the difference between life and death for a fellow human being. Finding additional help can be the action plan after this, but first we must truly listen with an open mind and heart, once we do not judge them or place are own burden on them.
Warning Signs of suicide:

1. A previous suicide attempt
2. Feeling hopeless/helpless
3. A propensity to deal with internal conflict via action
4. Anhedonia: meaning to experience no pleasure from activities usually found enjoyable
5. Clear plans- Talking excessively about suicide- Suicide Ideation
6. A recently experienced failure
7. Withdrawn from others into the body- this includes neglect of the body
8. An actual or attempted suicide by a partner or other close relative
9. Giving away possessions and making final wills at apparently strange times
10. The attempt to blackmail suicide
11. Collusion with others/ suicide pact
12. The loss of concern for their self/ body appearance/health
13. Strong perceived failure in life
14. Self destructive behaviour

This list is not exhaustive; likewise we can’t think that every sign here refers to a definite suicide risk, these can also be examples of the morning process, a normal life stage event or even just natural sadness! I realise this makes things all the more confusing, however what is important to note is that these are risk factors, they are something to be aware of and to watch when we see them. The important thing is to be open to them. Our own intuition is highly attuned to sensing danger and we are biologically pre-programmed as social creatures to sense when a member of our group is in danger. It is not always easy but if we allow ourselves to open up to the possibility of the distressing question “Are they thinking of killing themselves” we allow ourselves to be much more aware. In the end we can not help everybody and we do not have the gift of seeing the future, all we can do is our best. We may not even be able to see the change that is being made {it is not like you can see the scars healing}, but what we can do is instil hope.
The instillation of hope can be the most beautiful and compelling thing in this world for someone who can’t see the end of their suffering or the light in their life, please offer them an amount of this light.
References :

• Gelder et al Psychiatry 3^rd, Edition Oxford University Press
• Gillett The mind and its discontents
• Guide to Engaging the media in suicide prevention http://www.sprc.org/sites/sprc.org/files/library/media_guide.pdf
• WHO Preventing Suicide. Available online
• Suicide in Ireland A national study 2001. Dept. of public health. Available online
• Lester D. Suicide in Ireland. Ir J Psych Med 2010;(4): 198-204

***
Thank you to my wonderful brother for taking the time do write this post. Love you loads, bro.
Alan’s archenemy qualifications include:
Anthropology
Counselling
Psychotherapy
Alan spends his time working between three canters; one a listening service for children, another working with homeless and disadvantaged people who are at risk. His final area is seeing clients in private practice where a number of these issues arise.
If you or someone you know may be at risk of suicide please contact one of the following resources
Irish Contact Information:
1life: 1800 247 100
Samartians: 1850 609 090
The National Office for Suicide Prevention: 01-6352139 or 01-6352179
Aware: 01 661 7211
Childline: 1800 666 666
Local Doctors or GP: