Thoughts on suicide

Amy Winehouse once said: “Since I was 16, I've felt a black cloud hang over me. Since then, I have taken pills for depression.” Today there are many speculations about her life and death. The word suicide is combined from the Latin “sui” which means “of oneself” and “caedere” referring to “to kill”. Today we prefer to use the term “successful completion of suicide”. Even the Afrikaans term “selfmoord” is no longer used, but rather “selfdood”. Significant efforts are made to rather emphasise suicide as a mental health issue than an “act” that needs to be condemned”.

Any suicide threat must be taken seriously and urgent consultation with a doctor or mental health professional is of utmost importance. Paramedics and nursing personnel are trained to engage in emergency situations. Do not hesitate to phone the ambulance, police, fire department or hospital emergency department in an emergency. Useful information is available on http://www.sadag.org and www.lifelinesa.co.za or phone SADAG at 0800 567 567; Lifeline could also be contacted on 0861 322 322.

The perception exists that there is a correlation between a depressive mood and suicide, but a strong relationship also exists with anxiety and other disorders. Depression as such is not always the sole reason for suicide; there are many variables that could have an impact on the person. Traditionally it was thought that depression was the only contributor to suicide, but today we also know that the term ‘depression’ is sometimes generally used to describe a whole range of mood disorders.

“Depression” could be described as a mood or state of sadness, darkness and ideation recognised by its pessimistic nature with a loss of interest in life and pleasures that would normally be enjoyable. Feelings of worthlessness, guilt and shame would overwhelm the person and the ability to think or concentrate would also be negatively affected. Persons could struggle with weight and sleep, either weight loss or gaining weight, sleeping too much or struggling with insomnia. The person could also be preoccupied with death and suicide. It should be understood that the person feels powerless against the state of mind or mood that is currently experienced.

The French sociologist Emile Durkheim in 1897 wrote the book Suicide where he utilised survey data aiming to demonstrate egoistic suicide. Durkheim’s research concluded that self-reproach and sense of failure were more common among single than married people and that the phenomenon could be related to lack of social cohesion. He further argued that altruistic suicide stems from a need to benefit others and is found relatively common in Japan where the person might experience a sense of failure to society. Anomic suicide would arise from a sense that life has no meaning and is pointless and was found by Durkheim to be rare among Catholics; anomie could arise from an absence of social norms. Durkheim’s study could seem relevant, but today, with the development of psychiatry clinicians have a much better understanding of the variables that could contribute to suicide.

According to the World Health Organisation (WHO) a suicide is committed every 40 seconds somewhere in the world. The World Health Organization (WHO) speculates that approximately one million people yearly die from suicide worldwide. Predictions are that by 2020 this figure is likely to escalate to approximately 1.53 million people per annum. Many suicides and attempted suicides might go unreported, but statistics in South African in general seems to be alarming.

It is estimated that almost one in 10 teen deaths in South Africa are due to suicide. Suicide is the highest rising and second principal cause of death in the fifteen to twenty-four age groups. The National Youth Risk Survey found a disturbing number of high school teens were depressed and suicidal, more than 20% considered suicide in the previous month. In South Africa, children as young as 7 years of age have committed suicide.

Teens mostly experience suicidal feelings with overwhelming feelings of loss of control in their lives. Signs and symptoms of depression are mostly present. Teens experiencing a depressive episode experience such an inner emptiness and often feel that there is nowhere or no one else to turn to. The world is perceived as an empty and uncertain place that suicide seems to be the only solution to the current psychological tension experienced.

According to the South African Depression and Anxiety Group (SADAG) the following is only a few danger signs to look out for (sadag.org):
The person is talking or joking about suicide. There could also be a preoccupation with death present.
Signs and symptoms of Depression
Preparing for death, speaking about a definite suicide plan or writing goodbye notes. Here one should also be aware of messages that are being broadcasted via tweets and Facebook.
Giving away prized possessions or a testament is suddenly being drawn up for no reason at all
Negative view and experiencing of self.
Self-criticism and not even liking the self is regularly mentioned
Unexplainable changes in personality is observed by others
Sudden drastic changes in sleeping and eating habits. Persons could sleep a lot or even no sleep at all. The same with eating where there is no appetite at all or constant comfort eating.
Loss of interest in appearance and activities that in the past interested the person
Risk-taking behaviour such as drinking and driving or even risky sexual behaviour
Unexpectedly the person reports feeling recovered after the anguish of a severe depressive episode.

Assist a person who is at risk of suicide, remember to do three things: 

1. Consult with a professional and always seek for an additional opinion.
2. Ensure improved care for the person and all actions should be taken to protect the person as well as yourself.
3. Always document actions and decisions taken.

The person who is at risk should preferably be hospitalised especially when previous attempts of suicide is reported. The loss of a loved one could also increase the risk and talk of being reunited in death with the diseased should not be taken lightly. A family history of suicide should also be a warning as well as a history of reckless and impulsive behaviour. The presence of a chronic illness could also increase the risk and the examination or exploration whether the person has already made plans how exactly to commit suicide is of importance. Some persons would plan highly lethal means in detail, what is interesting is that persons who planned the suicide to the means, time and date would present that the depressive mood is starting to elevate.

Be accepting of the person and create an environment that is honest, empathetic and congruent. Do not do an emotional “dance” around the person. Assure the person of your intention to assist and help. Ask straight whether the person have thoughts of suicide and if current stressors present in the current experiencing of life could contribute to the need to escape the self.
Did the person have such thoughts before?
Do you have a plan?
Tell me.
Ask whether the person have access to the apparatus that forms part of the suicidal ideation plan, like a gun, pills, etc… gather as much information as possible. The signs of depression could be explored by discussing sleep, energy, vitality, weight or appetite changes. Openly enquire about decreased interest in sex and other pleasurable activities, feelings of powerlessness and hopelessness, social isolation and withdrawal from others...loneliness.

Do not enter into any arguments with the person contemplating suicide, do not try to “make it better” or “fix” the person’s current feelings. Remember that you might be dealing with a chemical imbalance and that suicidal thoughts might stem from an underlying psychiatric condition. Empathetic understanding of the person’s experiences as well as the assurance that the symptoms of depression are treatable will be necessary. Assure the person that professional help is always available and further that all “problems” could be talked about. To inflict further guilt and shame on the person would be unnecessary and would serve no purpose. Supportive empathetic understanding without judgement is thus of utmost importance, never leave the person alone or unattended. Once again, always seek professional help.

Always keep communication open and seek professional help:

It should always be remembered that a diagnoses should be made by a professional and that further guidance from this professional will be provided. How could one assess the situation? Communication that is non-threatening and open to acceptance might be the answer. A person who is suffering should feel emotionally safe to explore their experiences and fears. A person should not feel judged or that there “is something wrong with me”. The symptoms and signs should be discussed and the need for help should serve as motivation.

Ensure improved care for the person and all actions should be taken to protect the person as well as yourself. Always document actions and decisions taken. Everything you do and discuss with the person in need, conversations with professionals and the outcome of the consulting, every question you might have for professionals as well as statements and needs expressed by the person who is at risk should be documented.

A professional would evaluate a person’s risk and the contributing risk factors. A thorough mental diagnosis should be made, substance abuse and other mental health implications should not be left unaddressed. The person who is at risk should preferably be hospitalised. The loss of a loved one could also increase the risk and talk of being reunited in death with the diseased should not be taken lightly. A family history of suicide should also be a warning as well as a history of reckless and impulsive behaviour. The presence of a chronic illness could also increase the risk and the examination or exploration whether the person has already made plans how exactly to commit suicide is of importance.

Be prepared to listen:

Be prepared to listen to the person as a whole and not only focus on the problems being experienced. You may wonder what questions to ask, be accepting of the person and create an environment that is psychologically safe, empathetic and congruent. Do not do an emotional “dance” around the person. Assure the person of your intention to assist and help.

Empathetic understanding is of importance, at no stage of communication should the person at risk experience that there is not an effort made to understand him/her. The unique individual is experiencing crises and stress, despair and vulnerability, this should be accepted unconditionally. Discuss and explore possibilities for services, referrals and social support. Always motivate why further consultation and professional assistance should be sought. But, if it is experienced that persons can't stop themselves, call for an ambulance, the police, hospital/ER, crises line, therapist or chosen special family member. The person should agree to contact significant others that would provide care and stay with the family member(s) until the suicidal thoughts have been addressed in treatment. Hospitalisation would at all times be the ideal care, voluntary admission is advised and involuntary admission when crucial can also be done.

Change and growth:

Treatment should always be from a biopsychosocial approach within a multi-professional team that address whole-person needs. From a human potential stance, with the ideal circumstances for help and facilitation, change and growth is possible and has great potential. With Person-Centred facilitation and psychiatric intervention that addresses the person as a whole, the willingness and interest of others will form part of constructing an ability to create a new perceptive of future and willingness to address unsymbolised experiences, needs and dreams. The key might be not to give up on the process of change and growth, never stop seeking the help that fits with the person.

In asking how one could assist in this journey of up and downs, whether chemical or in an effort to construct a picture of the future, I prefer to turn to the founder of the Person-Centred Approach, Carl Rogers: “In my early professionals years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?
I have gradually come to one negative conclusion about the good life. It seems to me that the good life is not any fixed state. It is not, in my estimation, a state of virtue, or contentment, or nirvana, or happiness. It is not a condition in which the individual is adjusted or fulfilled or actualised. To use psychological terms, it is not a state of drive-reduction, or tension-reduction, or homeostasis... The good life is a process, not a state of being. It is a direction not a destination” (Carl Rogers: On Becoming a Person, 1961).

Jacques H Botes can be contacted on 083 892 4200 or psychosocialservices@gmail.com for appointment enquiries.

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