We Keep Getting Suicide Wrong

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First off, a disclaimer:  I am not a physician nor psychologist. I have mentioned that I am pursuing a doctorate in psychology but it is in applied psychology, not clinical. Everything that follows is my personal opinion and should NOT be construed as medical or mental health advice!

With two recent, high profile, deaths by suicide, awareness on the dangers of depression is peaking as would be expected.  The tragic deaths of Kate Spade and Anthony Bourdain, two people who seemed to be enjoying the pinnacles of success, have once again awakened us from our collective apathy on the subject, and as usual, social media has exposed our collective ignorance on what suicide is, within the context of clinical depression.

Comments and tweets aplenty and across the empathy spectrum from “How can someone kill themselves when they have everything they have ever wanted?”  to “They are cowards who have taken the easy way out!”.  So lets parse some things about suicide by looking at some common misconceptions about major depression.

“They have everything they want/need/could ask for, why can’t they just be happy?”

First off, when someone is suffering from major depressive disorder, they may be incapable of escaping the feelings of helplessness and hopelessness.  The fact that they seem to have everything they ever wanted, and still are depressed, literally defines clinical depression.  Anhedonia is the term used for the inability to feel pleasure, and it is often (but not always) a primary symptom of major depression. It is part of the illness, and in some ways the most insidious. It often seems so counter-intuitive that they can, in fact, be miserable inside. Often, it even creates a dissonance for the person with depression, they see how perfect their life is and the fact that they are still burdened with unbearable sadness, feelings of frustration and desperation becomes further exacerbated.

“It’s the easy way out.”

It was explained to me once by a suicide survivor, that when he made the decision to kill himself, it was like he was in a room on fire on the top floor of a skyscraper and he had to choose between staying in the room and dying a slow, painful death or jumping from the window and ending it quickly.  His window was an extension cord tied around a exposed I-beam in his basement, his jump was from a desk, and the only thing that saved his life was that the “plug-end” of the cord was already weakened, so after hanging for about 5 seconds, slowly strangling and writhing, the cord gave way and he landed on the floor with a badly sprained ankle and a wicked bruise around his neck.  For him, death seemed like an inescapable inevitability, not a choice at all and certainly not an easy one.  Despite his damage, he was one of the lucky ones, he survived and ultimately did get help, and he is extremely grateful for this now.

“Just stop being depressed”

It is like telling someone to stop having cancer, or stop being on fire.  A person with depression is not choosing to be depressed any more than a person chooses to have any other illness or life threatening condition.  This mindset is often at the heart of the stigma against mental illness, that it is somehow and for some reason, the person’s choice or their fault.  It is also the impetus behind some bad advice, “You should get more sleep”, “You should exercise more”, “Fix what is wrong with your life”, “Stop focusing on yourself so much”.

“They must have had some inner demons”

Again, when a person attempts or commits suicide as a result of major depression disorder, this is not an action of the person’s choice, It is the outcome of a debilitating, progressive, and in such cases, terminal illness.  Making these assumptions only promotes the stigma which precludes many people’s decision to seek help.  They start to wonder if maybe their depression really IS a result of their actions, maybe they deserve it from some previous misdeeds, maybe they can fix it themselves by making some changes like eating better and exercising; thus they delay seeking professional treatment.  And failure to fix things themselves only contributes to worsening symptoms of helplessness and hopelessness.

Clinical depression is a complex and misunderstood illness, even today the pathophysiology is not fully understood.  It is a mental illness, but that only explains the manifestation of many of the symptoms.  Current theories of the causes include everything from neurotransmitter dysfunctions to to immunologic and endocrinologic abnormalities, even differences in the actual structure of the brain have been observed.  We need to stop looking at major depressive disorder as just a mental illness (in my opinion we need to stop looking at a lot more than depression that way), we need to look at it as the progressive, debilitating, potentially fatal, but treatable illness that it is.

If you, or someone you know, is thinking of or talking about suicide, consider that it is a medical emergency.  Go to the nearest E.R., or at the very least call the National Suicide Prevention Lifeline 1-800-273-8255 immediately.  If you are with someone, stay with them.


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