I want to talk a little bit about
suicide which is related to the class of disorders we talked about
last time which is depression. It's also related to other disorders.There is an
elevated risk for suicide with a lot of disorders including things like
schizophrenia, bipolar.
Clearly most people see the connection with depression,
substance abuse, et cetera, et cetera. So suicide is something
that is a terrible, terrible outcome for what we think
by large in the mental health profession is a preventable
issue. Something that usually can be treated if a person
is aware that such treatments are available. If they are empowered and enabled
to access such treatments
usually the critical issues that lead them to the choice of attempt of suicide
are things that could be resolvable which is why people can be hospitalized
against their will. The way I look at it if you're completely depressed usually
you're thinking, we talked about the cognitive triad is skewed, right,
that you have a bias towards seeing things in a negative way, more black and
white thinking.
And from my way of looking at it, the worst time to make a life-and-death decision
is one you're affected by depression or some other kind of
really heavy life issue that prevents you perhaps from seeing all options. So you
look at suicide,
look at about a quarter million attempts a year...
text text text.
Quarter-million people about one in eight are completed. We don't say they're successful
that sounds terrible,
right. They complete suicide so most
suicide attempts were not completed but those which are
are devastating to the person's family
who lost them. Perhaps in some sense that person suffering is over
whatever led them to that but as I said by and large if we could have gotten them
in to treatment or gotten them some assistance or help,
we probably could have helped them solve the problem. Anybody could commit suicide.
We do see higher number in singles, unemployed, college students,
and high pressured professionals. There are certain demographics that have higher
numbers than others but
it's an equal opportunity thing. Turns out and you got the little astricks there we
saw that as a bonus item for your test, right? Females
attempt suicide more often. Males complete suicide more often.
There are some open questions as to why that might be the case
but one leading concept or idea is that
men are far more likely to use violent means of death.
Men are much more likely to use hanging, right. Which is a very
if, if done is very effective. They''re
are more likely to use guns. Which again are very effective means.
Women are more likely to use poisoning or
a carbon monoxide, asphyxiation that kind of thing.
Things that take time to occur, right. If you take an over dose of drugs you had to have taken
a drug that could be fatal, in overdose, you you have had to take it in a quantity
that would be fatal.
And other words a true overdose and then that takes time
at which point people can be discovered, rushed to the hospital, and saved.
After a gunshot wound or a drop
hanging there is very little you can do unless there was some kind of serious
a serious wound that was not fatal
in which case you might be able to save a life. About two-thirds of the people admit
in college to have thought about suicide. It's not uncommon thing
to think.
I mean in some ways if you are
philosophically minded at all, how would you get around the notion of thinking
what it might be like not to be here, right? I mean
kind of how do we define our presence is by just the concept of like what if I
had not been born or what if
what if I did die, what would happen? Those are not pathological things. Clearly that's
normative, right.
We look at statistical normality normal curve more people thought about it
than haven't thought about it.
So we're not just talking about thinking about it, we are talking about moving from a place
where
it goes from a thought, to maybe a plan
to maybe executing that plan. There are a lot of myths surounding
suicide people who talk about it. They don't actually do it. They are just
looking for attention.
I'll tell you this that is unlikely in most cases
and and it tells you something very serious.
If somebody was to be attempting to get attention
through that means, there's something wrong, right. Most people don't
attempt to get attention by planning suicidal
thoughts.So the people who talk about it sometimes do it but people don't
oftentimes talk about it and fewer people will talk with them about it.
I train healthcare professionals. I am an
instructor in a professional communication course. I teach a medical students, nursing
students,
pharmacy students, in addition to psychology doctoral students, right.
I'm adjunct in the faculty, adjunct faculty, in the Department of Family Medicine
to have health professionals interface with their patients
whenever they suspect there might be some kind of depression
or potential for suicideality. Because if you don't train them to do it,
people don't ask. And a lot of people who have completed suicide
and I can't remember the exact number but it's in excess of 50 percent
had been at their primary care provider in the thirty days prior to a completed
suicide.
Were I would say most of them were never asked whether they were suicidal or not.
They're probably talking about depression issues, possibly anyway,
they were probably offered an anti-depressant medication but they
probably weren't engaged
a prolong conversation about suicidal possibilities because it's a very
uncomfortable place to go.
It opens up a can of worms, there's a lot of time pressures and additionally
people don't know what to do about it. They are, they are hamstrung
to have a conversation where they don't know what they're supposed to do,
so we train people. But even after people are trained I've seen this
in that class, a fine class it is, let me tell you
to train people in communication skills most people just think
"I'm pretty good at communicating" not, probably not.
Not, not in a clinical interaction without some training you can certainly
enhance your
communication abilities but even after we train them specifically on this
there's a final
test where they engage working with a model patient, an actor pretending to be a
patient,
were there are issues of depression and most of them don't ask about suicide
after having been trying to do so. I did that with RA's, you all know what RA is, right?
Resident Advisers, Residents Assistants
in dorms. They have levels of responsibility.
They're supposed to be looking out. They're kind of the eyes and ears
of the University. At Virginia Tech I took part in training a bunch of RA's
on the issue of suicide and then we went through a mock
up situation where we had an actor in a dorm room
high-rise what looked like it might have been the butt of a gun sticking out from
under some books,
some pill bottles on the desk, darkened room and a person just kind of sitting on the
edge
and nobody in that group who had been trained asked about suicide,
asked about suicide. They just didn't do it
despite the training. It's a hard thing to handle so people have to be aware
that you need to talk to people.People who talk about it have a better chance
of getting out of it. They don't talk about. They oftentimes
aren't made aware that there are other options. So I would encourage you to talk with
people about it
without feeling the responsibility to save them because that you cannot
necessarily do.
Although you might save them indirectly by getting them help.
Suicide happens without warning - not really not usually - it seems to
sometimes because we ignored the warning signs
and retrospectively like I didn't see that coming. But
many times you can see it coming. People who attempt suicide are intent on dying.
They just want to die anyway.
There are some cases where people have clarity of mind where they make a
reasonable choice. In those cases we look at things like physican assisted suicide
were you have a chronic diseases that's incredibly painful, not
a cure in sight, and the person has to have the presence of mind to make a
rational decision
and even then there are a lot of legal hurdles. And there's a lot of people who
debate whether that should even be allowed.
And that's a moral debate, right. But the fact is the people who are allowed to do
it
have presence of mind, right. They have to go through a process
where they demonstrate they're competent to make that kind of decision.
But most people who attempt suicide don't really want to die.
Two-thirds of them at least don't want to die. Almost
another third ambivalent. I'm not really sure whether I did or didn't
want to die.
What they usually see is no other option.
They feel pressed against a wall and they don't know what to do.
And because they had this critical issue in their life that oftentimes leads them
to feel ashamed, or to
feel hopeless, or to feel like they have to
unburden other people, they make this decision. I worked with a guy once and he
had a job
working on high-power tension lines. Had been doing it for
decades, was nearing retirement. This is an upstanding member of the community. He
was in the emergency room in the middle of the night when I got called in on
call
to talk to the man because his wife had found he,
he admitted to her that he was thinking about sucide but he wanted to make it
look like an accident
so it wouldn't nnulify his insurance policy.
Because he wanted to take care of his family. What had happened was he had
developed a phobia
to working on those lines. He couldn't explain it. You all now know quite a bit
about how that might have occurred, right.
All those years it blew his mind that he could no longer do that
so he had been laying out of work. And laying out work was causing problems
with work
and he didn't see how you could ever go back and so he just thought well
I'm the provider, I can't do what I'm supposed to do as a man
so I might as well just off myself and get the insurance money to my family.
Of course his wife was horrified of that concept, right.
She didn't want to lose her husband because he didn't think he could do that
kind of job.
And I had a conversation with the man. A conversation with him. I didn't work no magic.
No therapist works magic. We just talked. And I said would you consider going to
the hospital and he's like "I really can't. I have to go to work tomorrow.
I've already laid out a lot days." And I said, "So, so
clarify with me this. You are pretty intent on dying." And he is like "yeah".
And I am like, "But you got to go to work tomorrow.
You couldn't go to the hospital because it's a life-or-death situation." And he's like, "Wow,
I never really thought of it like that." He never really thought about it like that.
He didn't think a lot of other things like maybe he could transfer to a desk
job,
right, in the same corporation, right. There were a lot of options possibly
open to him
but he had never engaged in a process of rational decision-making
to see what options were out there for him and that break
coming out of the situation going into a hospital situation
is not a great thing. Going to the hospital is not a thing of choice it's a thing of
last resort. If you've got somebody who is faced with dying
let's get them out of the situation they are in into a protected environment
were we can start offering them all kinds of support, help, options, et cetera
and help them think their way through the problem. Because guess what that
problem
as many are are solvable. But you have to think outside of the box. But you are not
thinking outside the box when you're in that kind of mindset. So
suicidal people stay that way until death? No!.
Treatment helps and most people get past it and they,
I have a former student Dese'Rae L. Stage
who actually has a a website called livethroughthis.org.
And what she does is she documents survivors of suicide attempt stories
and publicizes them so that other people can see that they're not alone.
And that's a student from right here at ETSU and has gone on survived her own
suicide attempt
is brave enough to talk about a suicide attempt in her own life
and brave enough to help other people bring that forward. So
this is what we have to get past. The stigma of mental illness.
Getting help is what we need. What could you do?
You can do a number of things.
The biggest and which is the last but take that suicidal talk seriously. Be
willing to have a conversation with somebody.
One of the problems with depression is that people get socially isolated when
they're depressed.
You know why? Because it's depressing to talk to depressed people, right.
Things are always down I'm like man I liked to talk to them. Man every time I talk to them
they're always talking about how bad things are.
Maybe things would clear up.And people start distancing themselves
from people who are suffering because the people are suffering
and the suffering is uncomfortable. So they walk away not in a mean way just
I don't know what to do. Well, just provide some empathy. You don't have to be
the lifeline
You don't have to be that person's go-to person at 2 a.m.
every you know week but if you can provide a little bit of social support a
little bit about I care about you and you will make it through this and your
valuable
and you should probably seek some additional help.
Identifying clearly clarified a crucial problem. There's often times one critical
issue. There's oftentimes satellites of
other issues that are related but usually there's one big one that's
really really the roadblock to them seeing
a future. Suggest alternatives to suicide. You'll get a lot of yes but, yes but
yes but
but suggesting alternatives might start them thinking about other alternates.
Capitalize on doubt. I've had one person actually
who said you know if it wasn't for my cats, I'd be dead.
She loved her cats. She lived totally alone. She thought if she had killed herself
no one would even know. Nobody would discover her body
and her cats would die because they wouldn't be feed. And I said, "Good.
Feed them cats. Stay alive to feed your cat. Let's start right there.
I've had other people say well you know if didn't think I was going to hell I'd already be dead.
I'm like, "Good. You might go to hell. I don't know.
If that's what you think, let's start right there.
Let's keep you alive for a while until we can start working through the issues
that are most critical to you. Whatever your doubt is, I'm going to capitalize on that
doubt
and I'm going to suggest to you that might be a really good reason it there's all
in one reason
that you're alive that is the most important thing in your life right now
let's
let's support that." And that encourages them to get help with professionals.
You can't save everybody. I've got one guy I work with
middle of the night and I had him sign a contract because I'd
check his ideation whether he had a plan, whether he had intent, and
whether he had any previous history of suicide attempts,etc., etc.,
I said I don't think you'll need to go to a hospital to night
if you can commit to me if you'll promise with me a thing called suicide contracting
signed that you'll meet me tomorrow morning at 10 a.m.
so we can talk further. And he goes, "signing this isn't
going to make me stop, this is not going to me not kill myself." I said I
know.
I'm asking you to promise me
that you won't do it until then. And if you feel overwhelmed by these feelings that
you will call 911 or
that you will call the suicide hotline and that you will get help until we can meet
again. If I didn't think you could do that you would be going to the hospital
whether you wanted to or not because I have the power to do that.
So you have to work your way through these situations on a case by case basis
for what's best for the person and professional help is the best thing you
can do for them.
Get them help.