Celebrity Suicides Bring Topic Out Of Shadows
The deaths of designer Kate Spade and celebrity chef and traveler Anthony Bourdain ignited a national discussion related to suicide and suicide prevention. The Centers for Disease Control and Prevention noted that since 1999, suicide rates are up nearly 30 percent nationally. Middle-age adults have had the greatest number of suicides and the most significant increase in suicide rates. The CDC determined that almost 45,000 people died at their own hands in 2016. A common question posed by those impacted by the suicide of a loved one is, “Why?” This question, of course, can never be definitively answered. I have seen the pain that families and loved ones of suicide victims endure. The impact is profound. The CDC has not been able to answer the “why” question, but it found common problems reported by those who had committed suicide prior to their attempt. Relationship problems, alcohol/drug misuse, financial distress, physical health concerns, criminal legal complications and experiencing an unspecified acute crisis were stressors that most commonly correlated with suicide. In addition, more than half of those who ended their life via suicide did not have a history of mental health treatment. However, the American Foundation for Suicide Prevention reports that 90 percent of those who successfully end their life had a diagnosable mental health disorder at the time of their demise. There is speculation that the 50 percent who are not in mental health treatment may have difficulty in obtaining psychological services due to a lack of insurance funding along with the prohibitive costs of treatment. Also, many mental health providers have lengthy wait lists and psychological treatment agencies are overburdened and dramatically underfunded. Increased social isolation, alcohol/drug addiction and gun ownership have also been identified as factors that contribute to suicide. One hopeful finding is that suicide risk and prevention has been thoroughly studied and researched. Suicidality is a temporary state and not an indelible personality trait. I have had many patients who have reported intentionally overdosing on toxic chemicals, waking two days later and then electing to not initiate a subsequent attempt. This speaks to the impulsive nature of many suicide attempts. It is accepted that most suicidal individuals have marked ambivalence; picture those old “Tom and Jerry” cartoons with the angel on one shoulder and the devil on the other. The angel encourages the suicidal individual to persevere and the devil encourages suicide. Many suicidal individuals have used this metaphor when describing the circumstances prior to a suicide attempt. Individuals with previous suicide attempts frequently disclosed more of just wanting acute emotional or physical pain to end and less of a desire to die. Identification of suicidal ideation and providing acute hospitalization for these individuals will likely prevent immediate suicide attempts. Suicide screenings by trained professionals is imperative in these circumstances. Research indicates factors that predict a future suicide attempt. Perhaps the most robust predictor is a past history of engaging in that same action. Thus, those with past attempts are more likely to have a future suicide attempt. Threats of suicide are also a predictor, should be taken seriously and necessitate a suicide assessment by a professional. This would include discovering a suicide note. Often, the author will state that the suicide note was penned months prior, but be mindful that the person continued to keep the note rather than destroy it. This is a clear reservation of the possibility of a future attempt and should be taken seriously. Also, engaging in high-risk behavior, hopelessness, depression, giving away possessions and lack of interest in the future are also considered indicators of suicide potential. Suicide risk assessment continues to develop. Matthew Nock, Ph.D., a Harvard University professor, has developed a system that screens for recent high-risk behavior and refusal to discuss suicidal thoughts or the severity of suicidal thoughts. His screening has reportedly been able to predict future attempts with 90 percent accuracy. This is important work given that Nock determined that 80 percent of those who attempt suicide deny such ideation in their final communications prior to the attempt. If you are concerned that someone in your life is suicidal, trust your instincts. Communicate your concerns to the individual and be willing to listen to their input. If someone discloses being suicidal, seek professional help immediately even if that person resists and avoid counseling the person yourself. Most important, all suicidal threats should be taken seriously, necessitating a professional evaluation.