Central  South  Dakota Medical News
The Clinical View
by P.E. Hoffsten, MD
6 March 2002

THE TRAGEDY OF SUICIDE

 I remember my mom and dad going out to a party one night when I was 8 years old. They walked down the block to a friend’s home and were going to be gone for the evening. They were back in a half an hour obviously very disturbed because Mr. Black had committed suicide. Mr. Black was a friendly man living about four houses up the street.  He had been going to the same party that mom and dad were going to.  He told his wife that he had to stop in the bathroom a moment, there was a gunshot and he was gone.  I remember the terror that I felt because it was said that nobody suspected this was coming.  I sure hoped that my mom or dad would not do a thing like that.  It was scary.

       Anyone who watches television recognizes that one of the most dangerous things in our society is someone with a gun but television doesn’t even begin to depict the true dangers.  The remarkable number is that suicides outnumber homicides 3 to 2.  If someone is going to get shot, it is most likely they will do it to themselves.  Suicide is the 8th leading cause of death in our society.  It is the third leading cause of death for individuals 35 year old and  younger.  In a discussion with colleagues recently, we could name 27 individuals in central South Dakota who had committed suicide in the recent past but only 4 homicides.

     The tragedy of suicide is quite horrible.  Those left behind are scarred with guilt, wondering what they might have done to prevent their loved one’s death.  The disruption of  a family leads to irreversible changes in the individual’s lives. Unfortunately, little has been achieved to decrease the suicide rate in our society. The suicide rate has been level over the past twenty years inspite of extensive studies and many a task force devoted to suicide prevention.  This is primarily related to the observation that 80% of suicides occur in males and are infrequently preceded by suicidal threats or discussion.  Two- thirds of all suicides are successful on the first attempt and thus attention prior to the event is very difficult.  Of those individuals who make a first suicide attempt unsuccessfully, more than half will make subsequent attempts and this is the group most amenable to some type of suicide prevention efforts.

       Prevention measures begin with recognition of suicide candidates.  A large majority of suicides occur in individuals who are depressed or alcoholics.  Seeking medical attention for the depression or the alcoholism and the use of medications has been shown in small studies to decrease the suicide rates significantly.  The common characteristic for the preventable suicide is an individual who is chronically depressed and tending to be isolated.  The person usually doesn’t feel that depression is a medical problem and is reluctant to seek professional attention.

       The critical time suicides occur is when disruptions of intimate personal relationships occur.  Commonly, the suicide victim feels estranged or abandoned from their loved one and lacks another significant other for counsel or comfort.  As the despair builds, the suicide thoughts begin to gel into “how to”.  This is a very dangerous time and by our state law constitutes a medical emergency.

 Steps to intervene for suicide prevention involves first recognizing the depression that precedes the suicide.  As strange as it may seem simply asking the person if they are thinking of suicide, is the single most critical step in its prevention.  Rather than “planting a seed”, asking the person if they are thinking of a suicide and how they are thinking of doing it, allows an “airing out” of concerns and provides a focal point for interventions.

       Once suicide ideation is identified and discussed, there are fortunately interventions for prevention.  Modern antidepressant medications are safe and effective in reversing depression. While alcoholism is more difficult to deal with, it too can be effectively treated provided the person is willing to help them self.  Professional medical and psychological help is strongly advised for the suicide risk person.

    As a last thought, my greatest sympathy goes to the families and survivors of the suicide victim.  They are most frequently left with questions regarding why and feelings of guilt and helplessness.  As two-thirds of suicides are successful on the first attempt and unannounced or discussed, the loved ones of a suicide need the comfort of knowing “it was not their doing”. There are things in our world that are beyond our control and while suicide prevention is something we strive for, it is still ultimately under the control of  the person who commits suicide and 30,000 times a year, that perpetrator is successful inspite of our efforts.  Those efforts begin with your local healthcare providers who are aware of depression and the problems it brings and who know enough to ask someone if they are considering a suicide.