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Suicide

Pathways to Suicide Prevention

Meaning, purpose, and relationships are key.

Key points

  • Social connections and meaningful activities can create a sense of belonging and self worth, which can be protective against suicidal impulses.
  • Combat the rise of social isolation by being part of causes and organizations that are larger than yourself and have altruistic goals.
  • Learn the foundational mental health needs that a person needs to build resiliency and avoid the despair that can lead to suicide.

In the months leading up to her suicide, Susan* (a suicide victim whose name has been changed and whom I wrote about in Part 1 of this blog) had told a co-worker that she wanted to find more meaning in her life. Unfortunately, at that point, she had suffered too much pain and depression fatigue. She could no longer wait until she could find such meaning and took her own life. Susan was intuitively onto something. Suicide is rarely desirable to someone who has a sense of meaning in their life.

Here, in Part 2, I tie suicide into a larger mental health problem that afflicts this country, and that includes and goes beyond the scope of the mental health system. Clearly, we must provide better access to affordable and effective mental health. Beyond the all-important function of professional help, it is critical to understand the foundational factors that can strengthen mental health and help to provide a protective shield against the hopelessness and loss of a sense of meaning that can precede suicide. These are not treatments per se. Nor are they the only contributors to a wish to live. Rather, they are concepts that contribute to the building of resilience, optimism, and other tools for coping with adversity.

Long-term strategies that build resilience and discourage suicide as an option

Meaning can be found in actions that benefit others and make a difference in their lives, be it to one person, such as one’s child, or to groups of others, such as in teaching, social activism, or to the patients of doctors and therapists.

Evan M. Kleiman and Richard T. Liu analyzed two national surveys (J. Affect Disord., 2013 Sep 5; 150(2): 540–545.2) and found that individuals with social support are 30 percent less likely to attempt suicide. The survey defines social support as anything that leads a person to believe that he/she is cared for, loved, esteemed, and a member of a network of social obligations. Undoubtedly, having supportive parents is very important. However, in the teenage years and beyond, it becomes particularly important to be able to speak frankly to friends and family members other than one’s parents, who do not live with the person. The findings show that people who have social support experience less suicidal ideation even in the presence of risk factors. They also experience more resiliency in the face of suicidality.

In Part 1, I noted that relationship problems are a leading cause of suicide. According to Thomas Insel, psychiatrist, researcher, and Director of the National Institute of Mental Health for 13 years, young people increasingly report difficulty making connections with others. Limited social interactions, especially a lack of closeness to others, can lead to intense loneliness. It is widely known that people can recover from trauma when they have good social supports.

Our increasing reliance on technology as a means of communication, socializing, and commerce, plus the emotional distance engendered by technology, make community and personal connections a disappearing way of life. I write about our remote society in my book, How Are You? Connection in a Virtual Age, a Therapist, a Pandemic and Stories About Coping With Life. The word “remote” refers to both its digital meaning and its connotation of personal distance. I also refer to this phenomenon as living online.

Even before the advent of the internet and the rise of social media, the ubiquity of suburban living and our car-based culture created a sense of isolation and loneliness among many. Gone was the town square where people were forced to have the frequent human contact that is so essential to mental health.

Indirect benefits of social support

A fascinating finding by Kleiman and Liu is related to the indirect effects of social support on suicide. The authors theorize that social support may reduce the rate of suicide by increasing factors such as self-esteem and a sense of belonging, two factors that are negatively correlated with suicidality. People who belong to a larger community have a sense of mattering to others. Self-esteem is derived from that feeling of mattering, of being needed, relevant, competent, and important.

Several times, I have heard someone who suffered a tragedy say that their will to live existed because they were needed. Most of us derive meaning from contributing to someone or something outside of ourselves. Such a sense of value allows us to embrace the urgency of life. Feeling valuable is what self-esteem is all about and is what can get us through adversity and maybe even save our life.

The self-esteem that comes more from meaningful involvements and purpose counters our culture’s emphasis on money, materialism, and celebrity culture.

Beyond family, friends, and neighborhood, structures and organizations that revolve around causes and beliefs, such as religious groups, community service, care for others, involvement in sports, theater, and even political groups, can provide a sense of mutual obligation and meaning outside of the self. That sense of meaning, coupled with the human connection that goes along with it, strengthens one’s inner resources and personal coping systems.

A larger mental health problem

“There’s a paradox at the center of the mental health conundrum,” says Insel, who recently authored Healing: Our Path From Mental Illness to Mental Health. Why, he wonders, are treatments and understanding of social supports for those experiencing mental distress better than ever, yet suicide rates in the U.S. have increased (while going down in other countries)? Anxiety, depression, and eating disorders have also increased, especially among the young. Half of the people who died by suicide never found access to mental health care. Determination of the answers to these questions is beyond the scope of this blog, yet they are important questions to ask and ponder. Insel’s answer begins with the idea that I raise in this blog: “Put simply, the mental health problem is medical, but the solutions are not just medical—they are social, environmental, and political.”

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.

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