Self Help - Suicide Awareness

Suicide is the act of intentionally causing one's own death. It's a myth that people who threaten to end their life will not do it. In psychological observations, the person who wishes to end their life will usually communicate it upfront. 

Potential suicides can be recognized before they act. They will disclose it to people who are close to them and to their psychiatrists & therapists. That is why suicide notes are evident in suicides. This article is to bring awareness to suicide and see what can be done. 

As per wiki, about 800,000 people die by suicide every year, and out of these, 135,000 are from India alone. Between 1987 and 2007, the suicide rate increased from 7.9 to 10.3 per 100,000, with higher suicide rates in the southern and eastern states of India. 

In 2012, Tamilnadu (12.5% of all suicides), Maharastra (11.9%), and West Bengal (11.0%) had the highest proportion of suicides. Among large population states, Tamil Nadu and Kerala had the highest suicide rates per 100,000 people in 2012. The male-to-female suicide ratio has been about 2:1. Suicide is the 10th leading cause of death worldwide. 

Psychologic Causes of Suicide

Sigmund Freud believed that the loss of someone on whom an individual is ambivalently dependent results in pathologic depression. During the period of mourning, the individual gets the image of the departed person and begins to have the same feelings toward the departed person. 

The unconscious hostility directed towards the lost person then becomes directed towards thyself and culminates in the act of self-destruction and self-hostility. 

People who commit suicide can be classified into four general types. 

1.  These beliefs lead them to realize that suicide is a transition to a better life or to save a reputation. (Eg. Hara-kiri, Seppukku, etc.)
2. People who are old, bereaved, or in physical pain consider suicide as a release from all those. 
3. People who are psychotic and kill themselves because of delusions and hallucinations.
4. People kill themselves out of spite, thinking that others will pay respect and mourn for them. The sad part is that they believe that they will watch the sorrows of others because of their death.

In "anniversary syndrome," a person who kills themselves on the same date of death of their loved one, or their birthday, or relevant, memorable years. One example is the lead singer of Linkin Park, Chester Bennington, who committed suicide on his deceased best friend's birthday. 

In the psychodynamics of suicide, severe losses and threats of loss take high priority. These include loss of health, loved ones, money, power, job, pride, beauty, honor, status, independence, friends, and family. 

In "empty nest syndrome," a person commits suicide because the children have grown and moved away. Chronic or terminal illness often contributes to loneliness, emptiness, and existential crisis that presages suicide. 

Suicide is understandable in soldiers as prisoners who face execution or, even worse, torture. Hopelessness correlates more significantly with the seriousness of suicidal intent. 

The cerebrocortical activities weaken because of high alcoholic intake, sleeplessness, and barbiturates (sedatives and sleep-inducers, which contain barbituric acid) and due to the weakening the neuropsychological approach that triggers the final decision to commit suicide increases. 

Sociologic Theories of Suicide

The more intimate the relationship, the less the wish for suicide. The suicide rate is higher in cities where people do not have time for relationships but less in rural areas where relationships are valued higher. 

The higher percentage is in the center of cities than in residential areas. Higher in widowed and divorced than among the married. There is a direct relationship between suicide and social status. 

One who considers social status as high is more prone to kill themselves when the status they believe is at high risk. The same applies to people in upper socioeconomic classes who have high chances of suicide. 

Comparatively, men commit suicide more than women. The discrepancy is because women are more protected in society, and mental health care is more available to them. 

Men are usually considered tough, and crying for help is not a choice. They struggle to ask for help in most cases which leads to suicide. These are all taboos in society, which lead to suicide. 

Cultural attitude toward suicide is another essential factor. In the USA, where suicide is condemned, there are fewer suicide cases. In Japan, where suicide is praised, there are more. 

Age also plays as one of the social factors. Teenage kids are more prone to suicide between the age of 15-19. 

Assessment of Suicidal Risk

Suicide attempts have to be appropriately assessed and evaluated by a psychiatrist. A physician could not recognize the factors and can only discover later that the patient has successfully committed suicide. 

The intervention of a psychiatrist or a psychotherapist is very much essential. Self-destructive behavior can range from accident-prone to self-mutilative or a protest demonstrator who instills fear in others. 

In assessing a suicide attempt patient, a decision must be made about the seriousness of the intent to kill themselves. 

A wish to die or subject to a state of panic should be regarded as potentially suicidal. The risk increases when combined with hallucination or delusion by which the patient receives a command to kill themselves. 

Depression is one of the most common precursors to suicide. Some of the depression symptoms include,

• Guilty over the death of a loved one (family or friend)
• Feelings of worthlessness
• A powerful wish to punish oneself
• Withdrawal and hopelessness

• Extreme agitation and anxiety

• Loss of the four appetites - food, sex, sleep, and activity

Danger Signs of Suicide

• Over half of those who commit suicide have a history of a previous attempt. The attempt suggests the level of the patient's suicidal intent. 
• A previous psychotic episode can lead to suicide. There is a possibility of recurrence which can increase the danger level. 
• A suicide note should be considered a dangerous sign.
• The method of suicide also defines the risk: more violence, the technique, and more chances of attempting suicide again. 
• Patients with severe chronic illness have the possibility of committing suicide due to a depressive response to the ailment. 
• The birth of a baby brings happiness to the mother while serving as a pathologic depressive reaction. Major surgery can carry the risk equally. 
• Alcohol, drugs, and sedatives bring suicidal impulses because of their effect on weakening controls. 
• Homosexuality, social isolation, bankruptcy, and other factors that usually lead to psychotic episodes are responsible for suicidal tendencies. 

Suicide Prevention and Treatment

• The most effective means of preventing suicide is to identify it early and treat it. Many NGOs and other organizations are available to help people who are suicidal. Many top-tier cities have suicide prevention help through toll-free numbers. 
• The sudden well-being of a previously depressed person should be monitored. They may feel relieved because of their decision made to die. 
• For patients who are already under treatment, antidepressant medication shouldn't be stopped abruptly. 
• Barbiturate overdoses can be fatal. Its effect of being suicidal is five times high as other tranquilizer drugs. 
• In appealing to a person who is threatening to jump on a ledge, use anything that he/she may respond to like religion, God, love, friendship, attention, warmth, and so on. People who are suicidal usually have "Tunnel Vision" and need a different perspective to expand their minds. Reminding the mother of her child usually stops her from suicide. 
• Try talking about suicide to depressed people if you feel that they have not mentioned suicide. Talking about it helps them open up, and we can see the possibility of their consideration.
• When a person is seriously suicidal, then the immediate solution is hospitalization. They should be kept on constant watch with suicidal precautions to protect them against their impulses.
• One or all of the treatments include 1) Drugs, antidepressants, 2) Psychotherapy 3) Electroconvulsive treatment. 
• Overhospitalization should be avoided, and the doctor's trust is the most valuable treatment. 
• In psychotherapy, a positive transformation will be seen. The therapist should know the patient more often even multiple times a day. Day or night, the therapist should be available for the patient to talk to. The therapist should be reachable for the patient unless things become routine. 

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