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Archive for the ‘preventing suicide’ Category

In a May, 2013, press release, the Centers for Disease Control and Prevention announced that in recent years, the number of annual suicide deaths in the United States has surpassed the number of people dying yearly in automobile accidents. In 2010, for example, 33,687 people died by automobile and 38,364 by suicide.

“Suicide is a tragedy that is far too common,” says CDC Director Tom Frieden, M.D. “[We] . . . need to expand our knowledge of risk factors so we can build on prevention programs. . .” (www.cdc.gov/media/releases/2013/p0502-suicide-rates.html)

Fortunately, Harvard psychologist Matthew Nock is attempting to do just that. In 2003, Nock and a colleague began developing a series of tests they consider potentially capable of detecting suicide risk. The tests are modeled on the Implicit Association Test originated in the late 1990s which uses word associations to reveal biases about race, sexuality, gender and age that people either don’t wish to acknowledge or cannot even recognize in themselves.

In short, Nock and his Harvard colleague have devised a series of tests to measure a person’s bias for and against being alive or dead. On a computer screen, “life” and “me” appear on one side and “death” and “not me” on the other. A person is asked to rapidly categorize a series of words such as “thrive,” “breathing,” and “funeral,” under one of those headings. Though complex in the execution, the tests basically detect how quickly a person identifies with either “life” or “death.” Hesitation in responding to the “life” heading, for example, might signal an association with dying that reveals a risk factor for suicide.

“Doctors of all kinds, including psychologists, do no better than pure chance at predicting who will attempt suicide and who won’t” writes Kim Tingley in a recent article in The New York Times. “Their patients often lie about their feelings to avoid hospitalization. Many also appear to mislead by accident, not realizing they are a risk to themselves or realizing but not knowing how so say so.” (www.nytimes.com/2013/06/30/magazine/the-suicide-detective.html)

Along with the hope Nock’s system brings to the worrisome field of suicide prevention, it brings deeper appreciation of my daughter Mary who died by suicide in 1995 at the age of 17. Several months before her death, Mary’s psychiatrist asked her whether she was thinking about suicide and heard, “No, I would never do that.” But maybe Mary wasn’t simply lying; maybe she didn’t recognize her risk or know how to talk about it.

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The previous three posts have dealt with the critical necessity of questioning a depressed (and possibly suicidal) person about whether he or she is considering suicide. It is, I think, the most formidable aspect of the Question, Persuade, Refer strategy for suicide prevention offered by Paul Quinnett on behalf of the National Alliance on Mental Illness (NAMI). It is challenging, for example, to overcome the denial that someone with whom you’re talking could actually be considering suicide. Also, it’s difficult to believe that asking that person directly about suicide is the right thing to do. Still, it remains the vitally important thing to do.

Quinnett’s second step is to Persuade the person to get help. “Ask the following questions: ‘Will you go with me to see a counselor (priest, minister, nurse)? Will you let me help you make an appointment with . . . Will you promise me?”

If the person resists getting help, a no-suicide contract should be proposed. That’s a promise that the person will not hurt him or herself until help is received. “Because making a promise appeals to our honor,” writes Quinnett, “and agreeing to stay safe relieves our suffering, the answer is almost always ‘yes’.” (If the answer is ‘no’, the person is to be considered a danger to himself and/or others and should be involuntarily committed for professional help.)

Other elements of persuasion involve reminding the person that there are better alternatives than suicide, focusing on those alternatives, accepting the reality of the person’s pain, and offering hope in whatever way one can possibly offer it.

At the same time, cautions Quinnett, the helping person should remove firearms, medications, car keys, and “other instruments which may be used to commit suicide.”

Finally, Referral is about getting the person to seek professional help and accompanying him or her, if possible, to the appointment. Someone helping a suicidal person need not be concerned with showing disloyalty or breaking a confidence–not when life is at risk, that is. (Paul Quinnett, PhD., “QPR: Ask a question. Save a life.” NAMI Family-to-Family Education Program: 2012).

Quinnett likens QPR to cardiopulmonary resuscitation (CPR) or the Heimlich maneuver: learn these techniques because you never know when you might be called upon to save a life.

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The first step to preventing suicide is questioning a depressed person about whether he or she is considering suicide, advises Paul Quinnett in his Question, Persuade, Refer strategy. “Giving a ‘yes’ answer to this question is often a release for the individual. It makes him or her feel better, not worse.”

Once the suicide question is under discussion, the questioner has a moral obligation to listen. “Listening is the greatest gift one human can give another,” writes Quinnett. “Advice tends to be easy, quick, cheap and wrong. Listening takes time, patience, and courage, but is always right. Give your full attention and don’t interrupt . . . judge or condemn. Listen for the problems death by suicide would solve” (Paul Quinnett, Ph.D, “QPR: Ask a Question. Save a life.” National Alliance on Mental Illness, Family-to-Family Education Program: 2012).

On the day before my daughter Mary’s suicide, I was questioning her, all right, but not about the one topic that might have saved her life. She had just come home from school that afternoon, and we talked for at least an hour about her school day, the weather, my sister’s upcoming birthday, the proper way to use a make-up brush, her skill as a math tutor to her younger sister, and other pleasant and lamentably pointless subjects. But I felt it was exactly the kind of positive, bonding conversation we needed on a day when Mary seemed to be recovering from major depression, and I think most mothers would have acted similarly.

I’m not dredging up that squandered opportunity to make myself feel bad seventeen years later. Mine was not a failure of love but, rather, a failure of knowledge. In other words, Quinnett’s Question, Persuade, Refer strategy is counterintuitive. It isn’t a process a mother (or anyone else) would instinctively figure out on the spot and put to use. It cuts against logic to bring up the word “suicide” with someone who is struggling with depression. That’s why grasping the system before it might be needed is vital and possibly life-saving. There is one last post to be offered on the subject.

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For the better part of two decades, I’ve wondered about the few minutes preceding my daughter Mary’s suicide. Just what sort of inner resolve did she summon in order to begin swallowing several dozen pills she knew to be lethal?

Well, now I know. Mary had to “pass a psychological barrier” before swallowing her pills and did so, it turns out, by way of champagne. “[A] final wall of resistance is what keeps many seriously suicidal people alive,” writes Paul Quinnett. “Alcohol dissolves the wall and is found in the blood of most completed suicides.” On behalf of the National Alliance on Mental Illness (NAMI), Quinnett adds, “If someone is contemplating suicide, keep them sober.”

Quinnett’s Question, Persuade, Refer system of suicide prevention can and must then begin. “Get the person alone or in a private setting and ask the person if he/she is contemplating suicide. Ask questions that acknowledge the individual’s distress. Questions like, Have you been unhappy lately? . . . Or you can ask directly, Do you want to stop living?” (Paul Quinnett, Ph.D, “QPR: Ask a question. Save a life.” NAMI Family-to-Family Education Program, 2012).

At this point, a dangerous fallacy must be exposed. It’s one I subscribed to, perhaps unconsciously, in relating to my daughter in the last days of her life. The fallacy is this: using the word “suicide” around a seriously depressed person will give him or her the idea of suicide that was not in their thinking before.

“Raising the issue of suicide with those who are severely depressed . . .. can open the door to therapeutic intervention,” writes Carol Anne Milton. “Allowing a person to talk through their worst fears . . . could provide them a lifeline that makes all the difference between choosing life and choosing to die. People already have the idea of suicide; it is in the media constantly. If we ask a person, ‘Do you have thoughts of suicide?’ we are showing that we understand the depth of their pain, that we care and that we take them seriously . . .” (The Coldest Night: A Family’s Experience of Suicide. Dublin: Veritas, 2009, p. 83)

The following post will continue with Quinnett’s plan of rescue for the beloved suicidal among us.

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