PsychSense: Sensible Psychological Solutions

There is a long complicated article in the NY Times today about suicide and impulsivity that is worth a read (if you can manage it.)

“Suicide autopsy” studies can give us lots of information, but no one really knows what goes through the head of a person just before he or she dies from suicide, it may be regret as suggested by one person interviewed by the author.

There are a few comments I would like to make about the article and suicide in general that are based on my own years of experience, and thoughts. If you can’t get through the article hopefully they will still make some sense to you.

In terms of the debate about impulsivity vs planned suicide; I believe that there is always an impulsive piece of suicide. People may have a long complicated plan in their head “just in case”, but it takes a trigger to finally push them over the edge. I wonder if sometimes this can be just the opportunity as well as it be the “last straw” type event. It is not an either/or choice.

One study indicated that victims of what look like highly impulsive methods of suicide (bridge, gun) often “display few of the classic warning signs associated with suicidal behavior” ” …jumpers have a lower history of prior suicide attempts, diagnosed mental illness…” It seems to me that these persons may have not been treated or recognized as being depressed which may put them at high risk.

Also the person who is most determined to kill them self may be less likely to let others know, due to not wanting intervention. Use of an almost guaranteed to succeed method, does not seem to me to be a sure sign of impulsivity.  Some people have been planning for a while and have chosen the method they believe least likely to fail, thus the use of a gun or a bridge.

I will never forget a man I saw years ago, who had given away all his possessions. He denied suicide, did not look in the least depressed, and had no psychiatric history. I would never have thought him to be suicidal.  If it hadn’t been for a family member who was very worried about his “generosity” with lack of explanation and forced an evaluation, I have no doubt this man would have killed himself. (He later admitted his intention).

Suicide is another one of those things we will never have all the answers for. There are many different motives and types of suicide: some with depression, some with psychotic thinking where voices are telling them to kill themselves, some with existential pain, some with physical pain, some with end of life issues. Some are carefully planned while others are impulsive. It is my belief that most have components of both.

Are we trying to categorize and understand something that may not fit into a neat clean framework? Our frantic efforts to figure things out are often attempts to control something we fear.

We certainly can help to prevent suicide, and we should keep learning, but we also need to acknowledge that there are some things we may never understand completely, and may never be able to control. Life and death are not so neatly black and white.

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