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By Wylie Tene and Sue Kolod, Ph.D.
Following the recent high-profile deaths of Kate Spade and Anthony Bourdain, a common question we hear is – “Can suicide be prevented if someone really wants to die?” While the question seems simple, it’s actually quite complex. The first part is easy: Yes, we can reduce suicide if not totally prevent it. The second part is more complicated and requires determining if those who died from suicide really wanted to die. Let us explain the ways we know how to save lives before tackling the second part of the question.
Research show that there are essentially four ways we know how to reduce suicide:
1) Restricting access to lethal methods: We know that putting time and space between someone who is experiencing a suicidal crisis and lethal methods of self-harm is one of the most effective ways to prevent a tragedy. Barriers on bridges, locking away guns, or hiding medications can often give those who are struggling something they desperately need: time. Time to change their mind, time to reach out for help, time for someone to intervene.
2) Safe media reporting and portrayals of suicide: More than 100 years of research show that certain ways in which the media reports on suicide and ways in which entertainment portrays it can lead to what we call suicide contagion or copycatting. Encouraging media to follow recommendations for safe reporting and Hollywood to use these guidelines for shows dealing with suicide can reduce the risk of contagion. It also helps to inform the public about warning signs, risk factors, and help that is available.
3) Decreasing stigma about mental illness: Studies confirm that nearly 90 percent of people who die from suicide have an underlying mental illness such as depression, bipolar disorder, schizophrenia, anorexia, and/or a substance abuse disorder. These may or may not be being recognized or diagnosed. We also know that shame, stigma, and misinformation about mental illness lead many people to not seek treatment. Talk therapy, often in combination with medications, is considered the most effective form of treatment.
4) Connectivity: More and more data confirms that having a strong sense of community helps reduce risk of suicide. Humans are social animals and isolation can be painful. This is not to say that those who have died from suicide didn’t have supportive friends and family or religious institutions. The vast majority do, but often the underlying illnesses can make them feel isolated, or they self-impose isolation, which is why one warning sign of suicide is someone withdrawing from friends and activities they use to enjoy.
Do those who die from suicide really want to die?
There’s a great quote from author David Foster Wallace’s novel Infinite Jest which addresses this question (David Foster Wallace died from suicide in 2008 after battling major depression disorder for 20 years):
“The so-called ‘psychotically depressed’ person who tries to kill herself doesn't do so out of quote ‘hopelessness’ or any abstract conviction that life's assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire's flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It's not desiring the fall; it's terror of the flame yet nobody down on the sidewalk, looking up and yelling ‘Don‘t!’ and ‘Hang on!’, can understand the jump. Not really. You'd have to have personally been trapped and felt flames to really understand a terror way beyond falling.”
In other words, what we know from research is that those who die from suicide are most often seeking an end to their severe emotional and physical pain and don’t really want to die. What is missing from Wallace’s analogy is that the person thinking about jumping from the building to avoid the fire may not be able to see the fire escape or the fire extinguisher that could save them. They cannot hear the sirens of the rescue crew on their way to help. In all likelihood the person has tried many ways to save their life and can’t take it anymore; the flames are just too hot. In that moment, they are not able to give consideration to how much pain their loved ones will be in when they are gone or how wonderful life might be tomorrow, because today they are burning.
Psychotherapy and proper drug treatment help to prevent suicides. The relationship with a therapist may stave off feelings of isolation and can help the patient see there are options other than suicide. Psychoanalytic treatment, in particular, also provides an opportunity for someone struggling to have their deepest fears heard and to be understood as a unique individual.
We can’t say that all suicides can be prevented. In fact, suicide rates in the U.S. have risen an alarming 30% since 1999, which suggests we need to look critically at public health policies, the funding of our healthcare system, and cultural attitudes towards mental health. We hope you will join us in learning about suicide risk factors and warning signs so that if necessary you can help someone get the support they need. You can be the smoke detector. You can be the rescue crew. Together we can reduce suicide.
