Suicide Awareness: Keeping hope alive   

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Susanne Fogger, DNP, CRNP, CARN-AP, PMHNP-BC, FAANP

Suicide Awareness Month takes place in September, but the topic of awareness is important to discussed year round. It’s important to keep in mind that suicide awareness must be more than “just call this 1-800 number if you are suicidal.” I believe suicide awareness requires one to consider the value and meaning of human life, and how individuals define these.

How does a person arrive at the decision that death is preferable to living in this world? Some feel choosing to end your own life is inconceivable and not something that anyone they know would do. However, suicide is not unique to one group of people. Suicide is not restricted to any age groups, genders, races or cultures, and it is the second leading cause of death among individuals ages 10-54. Unfortunately, research shows that aspects of our society may be contributing to an increased number of people choosing death over life in the past 20 years. The National Institute of Mental Health reports suicide is the 10th leading cause of death overall in the United States, claiming more than 47,000 lives in 2017.

Statistically, American Native/Alaskan Native people have the highest rates of suicide followed by white non-Hispanic people. Asian and Pacific Islander populations see lower rates of suicide. It should also be considered, however, that the data on suicide is not precise, as some deaths that are intentional are staged to appear accidental.

Why do people choose suicide?

The world’s and society’s methods of communicating have changed rapidly in the past 20 years as the proliferation of technology has connected some communication to a keypad, yet the human need for connectivity and purpose has not changed. Human beings desire a sense of belonging, to feel accepted and wanted, and suicide can be considered a response to being unaccepted and unwanted, even if that opinion is only in the mind of the individual.

Suicidal ideation often is paired with a physical illness such as major depressive disorder, or some other chronic illness. Hopelessness and a lack of a perceived future may be the predominant cognitive process prior to the decision to end one’s life. Sometimes a desire to hold the ultimate control of your own life manifestes as choosing when to end it.

Why do people choose suicide? We hear stories about teens who take their life because they are unable to cope with negative emotions, stress of peer attacks or bullying via the internet, or of individuals overwhelmed with depression that have thoughts distorted by their illness. These thoughts may take on delusional qualities despite family attempts to convince the person they are loved and wanted. The depressed individual may believe their brain’s commentary about their worth and role in the family and society. These negative cognitions, often unspoken, confirm one’ s sense of worthlessness and hopelessness.

Alcohol, often considered to be a social cure-all for stress, as a depressant agent it can contribute to depressed mood and suicide. Alcohol and the consequences of use may further isolate an individual from alternative solutions. Often the use of alcohol enables individuals to silence the rational aspect of their brain as they consider death as a solution to the pain of their experience. Other substances such as cocaine, opioids and methamphetamine can initially make people feel less stressed and believe they can manage anything. Over time these drugs create dependency and deplete natural neurotransmitters, so the person does not feel normal unless using. Unsupported withdrawal for a person dependent on these substances can lead to intense feelings of depression, hopelessness and suicide.

When someone chooses death over life.

Guilt can become overwhelming after someone dies by suicide, but it is important to remember that the decision was not about you. Consumed with their own pain, the person chose death over life. For some people, there is nothing that would change the outcome. We all struggle with wanting to know “What were they thinking?” or “What could we have done differently to have prevented this?”

Forgive yourself for not knowing.

If someone has suicidal thoughts and reaches out, recognize that asking for help is risky. Asking for help suggests their decision is not made. However, confiding in others is a trust issue. In asking for help, this individual may not want others to “take over” to “keep them safe.” In fact, they may perceive well-meaning intentions as not really going to change the underlying issues. It is very difficult to keep a person safe who makes a commitment to die. Adults who commit suicide have made a choice. We can only hope to keep them safe long enough to change some of the conditions which brought them to consider death in the first place.

How can you help?

If you have children who are under age 10, task them with increasingly difficult activities. Support them as they respond in frustration and guide them toward making good decisions. Children need to learn how to manage their own frustration and distress, and that can be a valuable tool moving forward in their lives. The ability to cope with difficult tasks can help ward off negative feelings or a low self-worth.

If you know someone is depressed and withdrawn, ask if they are having suicidal thoughts. This question does not make them act on their thoughts, but instead, talking can help the person see options to life they could not see on their own. You may need to help them get into treatment. Therapy and medication really do help.

Yet, getting people help is often complicated. The person may need guidance to navigate medical systems and not give up when they encounter roadblocks. Simple things such eating a meal if they have not eaten in some time or avoiding substances such as cocaine, methamphetamine or alcohol is a good start. As a psychiatric nurse practitioner, I work with people who have depression and who despair over a life of trauma, poverty and loneliness.

Hope is the one thing that can convince people that hanging around to see what happens next. Hope is a gift that anyone can give to inspire suicidal individuals to wait long enough for change to take place.  Suicide Awareness is not just a month of the year but a way of embracing the value of life and instilling hope where none exists.

For more information, go to the National Institute of Mental Health: https://www.nimh.nih.gov/health/statistics/suicide.shtml

Dr. Susanne Fogger writes a monthly blog post for the UAB School of Nursing blog. For her previous posts, click below:

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