Frontpage Forensics

Law and order from the couch

Suicidal Thoughts

Is it "normal" to think about suicide?

“What’s the big deal? Everybody has suicidal thoughts at some point.” Hearing this kind of rationale is not unique to my busy practice on an inpatient psychiatric ward. I hear it routinely from patients trying to negotiate their way out of the locked unit, and I also hear it from my friends and family who still think that psychiatrists overanalyze everything.

The truth is that suicidal thoughts, even the fleeting ones, are a very serious symptom of illness. They are highly correlated with worsening health, serious self-injury, and death.

Glib remarks such as “everybody has them” perpetuate the myth that suicidal thoughts are part of a normal human experience and imply that suffering individuals should just deal with it themselves. Society does nothing to reduce the stigma against mental illness when they discourage individuals from taking their thoughts of violence seriously before they worsen and lead to disastrous outcomes.

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Routine in the news are stories about mass shootings and completed suicides. Major psychiatric disorders that are linked to violence, like depression, are vastly underreported and therefore, undiagnosed and untreated. While healthcare professionals routinely screen for depression and suicidal thoughts, it is every individual’s responsibility to accurately report their symptoms. This can be difficult in a culture that routinely chalks violent thoughts up to a “normal” consequence of being human.

There is tremendous help for people who have dangerous thoughts. Treatment plans are patient-centric and tailored to reduce the risk of harm in a given individual. Some options include brief inpatient psychiatric hospitalization, a rigorous outpatient therapy plan, education about firearms-related suicides, and medication management.

Reducing the stigma against mental illness and stopping unnecessary deaths starts with negating the message that people should deal with thoughts about death on their own. Suicidal thoughts, any dangerous thoughts, are not normal. They are extraordinary symptoms and it’s okay, even healthy, to report them and get help.

Helen M. Farrell, M.D., is a psychiatrist with Harvard Medical School. She researches forensic psychiatry and violence.

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