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Archive for the ‘warning signs for suicide’ Category

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“It was so sad,” writes Colbert King in The Washington Post describing what he witnessed one recent September morning. “The body was covered with a white sheet. It was lying on a grassy area beneath the Duke Ellington Memorial             Bridge. . . . The only movements were the flashing red lights of police cars and motorists directed around the scene by officers.”

Later in the day, King learned that the body was that of a young woman, a seventeen-year-old high school senior, who had jumped from the bridge. “Of course [her] life was more than that leap to her death. A lifetime went with her. . . . All of it had to have added up to something–at least enough to want to keep living. . . . I wished I had known her long enough to have had the chance to do something: to hear her out, help her out. To try to undo whatever damage had been done . . .” (Colbert King, “I Didn’t Know the Woman Who Committed Suicide, But I Mourn Her,” washingtonpost.com).

When my seventeen-year-old daughter Mary died by intentional overdose in 1995, I agonized similarly: I wished I’d known her; I wished I’d heard and helped her out, undone whatever damage had been done to her. But unlike King, I was no passerby: I had known the person who died by suicide. I’d already had my chance at hearing and helping her. I’d thought that the damage done her by major depression was being undone by psychotherapy and medication.

As a responsible journalist, King includes some of the warning signs of suicidal thinking and behavior offered by the American Foundation for Suicide Prevention that everyone should know and take seriously: someone talking of killing himself or herself, an increasing use or abuse of alcohol or drugs, internet searches for suicide methods, the purchase of weapons, reckless behavior, withdrawal, saying good-bye, giving away possessions, etc.  (See afsp.org for complete list.)

Sixty-four people commented online about King’s column. Most were sympathetic to the young woman, some thanked King for his sensitivity, a few tried to blame the harshness of life and the general inability to attend to another’s pain.

Memorably, one person appealed to literature for the truth about love that is capable of transcending human limitation and devastating, inexplicable behavior. From A River Runs Through It, a compilation: “Help . . . is giving part of yourself to somebody who comes to accept it willingly and needs it badly. . . . we can seldom help anybody. Either we don’t know what part to give or maybe we don’t like to give any part of ourselves. Then, more often than not, the part that is needed is not wanted. And even more often, we do not have the part that is needed. . . .  It is those we live with and love and should know that elude us. . . . but you can love completely without complete understanding” (Norman Maclean, A River Runs Through It, Chicago: The University of Chicago Press, 1976, 81, 103).

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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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“It is a myth that suicide can’t be prevented,” writes Paul Quinnett. “It can. QPR is one technique that can help. QPR stands for Question, Persuade, Refer.

Quinnett speaks to those for whom suicide isn’t merely an abstraction occurring “out there.” On behalf of the National Alliance on Mental Illness (NAMI), he educates people whose family members live with certain brain disorders (mental illnesses) that can make them particularly susceptible to suicide. The threat of suicide lurking within those families is what, I think, drives Quinnett’s no-nonsense advice.

Overcoming denial is an important first step for the person who is trying to help someone considering suicide. “Sometimes, because the thought of death is so frightening,” writes Quinnett, “we deny the person may be suicidal.” But someone on the verge of suicide usually provides warning signs that must be taken seriously. (See November 1, 2012 post: “Warning Signs for Suicide.”)

One surprising warning sign is sudden happiness, for no apparent reason, in someone who is depressed. “Since depression saps energy and purpose, sometimes the depressed person is ‘too tired’ to carry out a suicide plan,” says Quinnett. “However, as the depression finally begins to lift, the person may suddenly feel ‘well enough’ to act. As strange as it sounds, once someone decides to end his or her suffering by suicide, the hours before death are often filled with a blissful calm” (Paul Quinnett, Ph.D, “QPR: Ask a question. Save a life.” NAMI Family-to-Family Education Program, 2012).

On the weekend of her suicide in 1995, my daughter Mary went to a video store with her father and sister on Friday night, offered to go to the grocery store Saturday afternoon after I sprained my ankle, helped clean up the kitchen following supper that evening, and then later ate ice cream and watched a television program, probably “Saturday Night Live.” As her mother, I was relieved at this normal-appearing behavior in a daughter who seemed to be recovering from depression. What I didn’t know, of course, is that she was also penning her suicide note that Saturday in between all the normal-appearing activities.

Any one of a hundred moments would have been the moment to ask Mary if she was thinking about suicide and, yes, the question likely could have saved her life. But it wasn’t going to be asked on a day when I was seeing improvement and hoping for the best.

There’s still more to say about Quinnett’s “Question, Persuade, Refer” system.

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Yes, I saw some but not all the warning signs for suicide before my daughter Mary committed suicide in 1995. Had I been aware of the significance of the behavior patterns I was picking up in my daughter, perhaps I would have understood the urgency of her medical condition and acted protectively on her behalf.

The National Alliance on Mental Illness (NAMI) lists the following behaviors as suicide warning signs:

1) Talking about death or suicide
2) Talking about specific plans someone has made to attempt suicide
3) Severe depression, hopelessness, or guilt
4) Reckless, violent, or self-destructive behavior
5) Alcohol or drug abuse
6) Expressing a sense of worthlessness
7) Suddenly appearing much better, or happier, for no apparent reason; and
8) Loss of interest in usual sources of pleasure

Mary never talked about death or suicide; certainly there was no mention of a “plan.” I saw no sign of alcohol or drug abuse. She was suffering from and being treated by a psychiatrist for depression. I thought a sense of worthlessness and loss of interest in the usual sources of pleasure were to be expected and would be alleviated by the drug therapy and psychotherapy she was receiving.

What I didn’t do that NAMI says I should have done was ask Mary if she ever thought about suicide. If she’d said “Yes,” I then should have asked if she’d thought about suicide recently and whether she had a plan. If she’d said “Yes” to that question, I should have considered her condition a medical emergency and not left her side until she got the medical help she needed.

But there was terror, denial, and general human messiness working against that logical strategy: I was terrified on some level for my daughter and denying all along that she was truly sick and in desperate need of a hospital. I think she might have been terrified and swimming against denial, too, incapable of admitting her self-destructive thoughts either to herself or to me. Had I been better educated about the warning signs for suicide, however, I believe it would have made a crucial difference (“Do You Care for Someone Who’s At Risk of Suicide?” http://www.nami.org).

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