Carrie Barron M.D.

The Creativity Cure

Suicide

Sharing a story, trying to understand

Posted Jul 17, 2018

Sam was close to his cousin who died by suicide when he was 18 and she was 25. (The details have been changed.)

I remember the last time I saw Hannah. We were riding in the car to pick up ice for a family gathering. She had this far-away look. It was as if she didn’t hear me when I asked her when we were supposed to be back or what was for dinner. She just didn’t answer. I let it go.  It didn’t matter cuz she was always nice to me. I just loved being with her. Her driving, me on the side.  She had wavy brown hair, she’d sing along with Linda Ronstadt, she played the guitar and painted these dark flowers with watercolors, runny, like they were spilling out of themselves.  Her eyes were kind.  There were always these fights with my aunt and uncle about smoking weed, cutting school, refusing to play sports or be a cheerleader like so and so, date guys. They went crazy over her clothes. She wouldn’t wear the pink and green whatever it was.  Hannah wasn’t a fit for the day or the family or Texas in the 70s. Trying to change her, make her do what she didn’t want to do, couldn’t do, was messed up. I think they were afraid of what other people thought. They were ashamed.  There was a lot of, “How could you do this to us?” Anyway, one day she went to their lake house and hung herself….”

A reader asked me to write about suicide, given recent celebrity deaths and the growing trend. It has increased by 30%in many states over the last two decades. https://www.npr.org/sections/health-shots/2018/06/07/617897261/cdc-u-s-suicide-rates-have-climbed-dramatically Why do people do it?  Why do people who seemingly “have at all” or at least the means to make a life change, decide to end it rather than re-invent themselves and their situation? Perhaps imagination fails. The inner script is bleak and feels immovable or maybe there is a troubling secret.  In a dark state, it can be hard to see possibilities for change.  Perhaps performance-pressure for highly successful public personas gets to be too much or a hedonistic treadmill sets in.  It might be hard to dial down into a simpler existence.

Suicide is such a devastating experience for those left behind. Many questions linger about how it might have been prevented. “What should we have done? How could we not have seen? What if…?” There is much we cannot predict, control or perceive with regard to another person’s inner life or determination. An attuned and skillful listener, from neighbor to pastor to therapist might help someone through a dark phase, shift the inner narrative and give rise to a bit of hope. Not always, but sometimes. Perhaps we can get better at hearing, seeing, reaching out, asking questions and understanding. Strong connections to other people protects health as described in a scientific study presented in this TED talk. https://www.ted.com/talks/robert_waldinger_what_makes_a_good_life_lessons_from_the_longest_study_on_happiness

The APA https://bit.ly/2scfI2n website lists triggering factors for suicide which include mood disorder, loss, trauma, pain, substance use, previous attempts, family history and access to methods. Researchers have found that absence of hope (1) and optimism, (2) low social integration and sense of meaning, (3) feelings of entrapment or defeat,(4) shame, humiliation and anger, perceived criticism, perfectionism, (5) fear of failure and a desire to escape (6) can also lead to suicide.  The Interpersonal Theory of Suicide purports that the combination of two hope-crushing factors – “thwarted belongingness and perceived burdensomeness” can lead a person to take their own life. https://bit.ly/2zD6bFa  

Financial stress can also be a catalyst but, as we have seen of late and as this Edwin Arlington Robinson poem illustrates, wealth does not render one immune from despair.

Richard Cory  by Edwin Arlington Robinson

Whenever Richard Cory went down town,

We people on the pavement looked at him:

He was a gentleman from sole to crown,

Clean favored, and imperially slim.

And he was always quietly arrayed,

And he was always human when he talked;

But still he fluttered pulses when he said,

"Good-morning," and he glittered when he walked.

And he was rich—yes, richer than a king—

And admirably schooled in every grace:

In fine, we thought that he was everything

To make us wish that we were in his place.

So, on we worked, and waited for the light,

And went without the meat, and cursed the bread;

And Richard Cory, one calm summer night,

Went home and put a bullet through his head.

One consistent and hopeful finding is that social integration engenders a three-fold decrease in suicide. (7,8) 

1.        Vatne M, Naden D. Experiences that inspire hope: Perspectives of suicidal patients. Nursing ethics. 2018;25(4):444-457.

2.        O'Keefe VM, Wingate LR. The role of hope and optimism in suicide risk for American Indians/Alaska Natives. Suicide & life-threatening behavior. 2013;43(6):621-633.

3.        Kleiman EM, Beaver JK. A meaningful life is worth living: meaning in life as a suicide resiliency factor. Psychiatry research. 2013;210(3):934-939.

4.        Siddaway AP, Taylor PJ, Wood AM, Schulz J. A meta-analysis of perceptions of defeat and entrapment in depression, anxiety problems, posttraumatic stress disorder, and suicidality. Journal of affective disorders. 2015;184:149-159.

5.        O'Connor RC. The relations between perfectionism and suicidality: a systematic review. Suicide & life-threatening behavior. 2007;37(6):698-714.

6.        Baumeister RF. Suicide as escape from self. Psychological review. 1990;97(1):90-113.

7.        Tsai AC, Lucas M, Sania A, Kim D, Kawachi I. Social integration and suicide mortality among men: 24-year cohort study of U.S. health professionals. Annals of internal medicine. 2014;161(2):85-95.

8.        Tsai AC, Lucas M, Kawachi I. Association Between Social Integration and Suicide Among Women in the United States. JAMA psychiatry. 2015;72(10):987-993.

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Source: Carrie Photo

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