Tipping the Balance Against Suicide

Tipping the Balance Against Suicide
By Dr Leow Chee Seng
Senior Consultant of Yale Consultancy Sdn Bhd
Fellow of British Institute of Homeopathy
Certified Stress Management Consultant, USA

During attending lecture by Dr Maznah Baba, from University Putra Malaysia, I was exposed to various concept of mental health. According to Would Health Organisation (WHO), mental health refers to state of well-being which release his own ability and cope with normal stressors of life; can work productivity fruitfully and able to make contribution to the community. In fact, the definition is ambiguous and it depends on which angle you are interpreting it. It is impossible to know for sure if a person who seems sad or who has changed for the worse is at a real risk for suicide. Nobody can ever predict how another person will react to the more troubling or difficult things in life. Different people handle different situations in different ways - this is a fact of life no matter how old you become. But there are some clear warning signs that a friend may be in trouble and that suicide may be something they are considering.

Since suicidal wishes are a prevalent and potentially lethal problem in depressed patients, it is important for the therapies to understand why the patient is considering such a drastic action. The therapist will then be in a better position to select appropriate and effective techniques to deal with the particular problem. However, no anti-suicidal strategy is of any use unless the therapist is able to detect and assess the degree of suicidal intentionality.

Common Suicide Risk Indicators
Clues to suicide plans may be detected in overt behaviours such as secretiveness, a sudden decision to make a will, or verbal statements. A suicidal individual may say, for example, “I don’t want to go on living” or “I want to end it all.” Other statement suggestive of suicidal intent include, “I’m not going to put up with it anymore,”, “I’m a burden on anyone,” “Things will never get better,” and “My intent is indirect and may be pieced together only in retrospect. For example, I have experienced getting statement, “I guess I won’t be seeing you again” or “I want to thank you for trying so hard to help me.” For a depressed patient leaving on a weekend pass from a hospital. Or on retiring for the night, the patient may say “goodbye” instead of “goodnight”. Researchers have noted that individual tend towards suicide more than others. The characteristics associated with such at-risk adolescents include the following:

A previous suicide attempt
Suicidal gestures (cutting off one’s hair, self-inflicted cigarette burns, other abuse of self)
A tendency to be socially isolated (having no friends or only one friend)
A record of school failure or truancy
A broken home or a broken relationship with a significant other (family member, boy/girlfriend)
Talk of suicide, either one’s own or that of others
A close friend or relative who was a suicide victim
Not living at home
Preoccupation with death or dying
A recent significant loss or the anniversary of one
Sudden disruptive or violent behaviours
Being more withdrawn or uncommunicative and isolated from other than usual

The most common external causes - or more accurately, external catalysts - of suicidal behavior are bullying, peer pressure/incidents, family crisis’s and health problems. Usually these are situational in nature and have an escalating history that has led the individual to feel as if they have no other way out. In their mind the situation has reached a breaking point and they see no other way out except death, or the threat of death. When external forces become unbearable enough for a person to contemplate suicide depression of some sort is always involved. The depression causes the individual to make irrational decisions based on unstable emotions.
This type of suicidal tendency is often accompanied by “after-death” fantasies in which the now dead individual, after taking their own life, gets to view the reactions and grief of those they left behind. In these fantasies the people that have caused the psychological pain feel punished by the suicide and in their grieving they demonstrate great remorse for having driven the person to take their own life. In this type of suicide (or suicide attempt) the individual is attempting to take back control in a situation that they feel is totally outside of their control. In killing themselves they are taking back control and getting in the last word and if the real life situation has left the individual feeling totally helpless the idea of going out in control and teaching other people a lesson in the process can be strangely appealing.

Suicidal urges that are brought on by external circumstances unwanted pregnancy without a support system, abuse in the family, abuse in a relationship, sexual assault, sexual harassment, bullying, peer rejection, and romantic rejection. The individual is intrigued by the fantasy that they would be getting back at somebody who they feel has hurt them and that this somebody will see the error of their ways and feel tremendous guilt, they are often fleeting in nature and happen in a moment of extreme emotional stress, they are more likely to fail, be repeated and escalate in severity with each repeated attempt. Under these circumstances the suicide attempts are often dismissed as cries for attention, which can be a fatal mistake on the part of the people close to the suicidal individual. Since the root cause here is a deep and wounding sense of helplessness being ignored or having others dismiss the attempts as attention seeking can lead to the person successfully taking their own life. Ironically when the external causes are addressed and dealt with and the person’s sense of helplessness is overcome the suicidal urges all but disappear.

Internal causes of suicidal behavior are much more complex and harder for the average person to see than external causes. The most common internal causes of suicide or suicidal behavior are clinical depression, psychiatric disorders or chemical imbalances. Essentially all suicide attempts come down to something inside the suicidal person but those without external catalysts are often biological in nature. Severe depression, which is believed to be caused by a combination of external factors and internal chemistry, is one thing that almost every suicide or suicide attempt has in common, how that depression came to be is the only difference. Some people suffer from depression because of chemical imbalances and to outsiders their lives seem great, or at the very least average, with nothing outstanding that would indicate a reason to want to die.

Practical Tips on Balancing against suicide

It is important for friends and therapist to “play for time” until the dangerous period for suicide has passed. The strategy used to involve patient to get himself involved in the process of therapy that he decides to :stick it out” until he sees where the therapy is going. This can be done by stimulating interest in his therapeutic approach. On top on it, the therapist should maintain continuity between sessions.

Involvement of patients on the treatment plan helps to treat the decision to commit suicide as the outcome of the struggle between the patient’s wishes to live versus his wishes to die. As in a declaration of war, an irrevocable decision may be made on the basis of a margin of a single vote, as it were. Initially, therefore, the therapist’s efforts should be directed towards shifting the votes in favour of living.

Once the patient has agreed to weigh the pros and cons of suicide, the therapist would elicit “Reason for Living” and “Reason for dying.” Although patient might forget reason for living, we can guide them by asking them to think of happy moment. The next step can be done by technical aid by drawing two columns on a sheet of paper. The therapist and patent can then list reasons in favour of living that were valid in the past. The therapist proceeds to ascertain which of the “past” reasons for living are valid in the present or at the least might be valid in the future. It is interesting to note that the suicidal patient has often nullified these positive factors in his life that he has forgotten them; ignore them or discounted their value.

The therapist should also recognize that it may be quite painful for the patient to reconsider his decision to kill himself. The patient may have undergone enormous turmoil before arriving at his decision to terminate his suffering via suicide, and reopening the question may mean to him that he will have to go through another period of turmoil and prolong his plan.

Summary

When dealing with depression, hopelessness, and fear, it is difficult to know where the bad feelings end and real risk begins. If your friend exhibits two or more of these warning signs in a close period of time it is best that you try to help. This does not mean you should take the weight of their world upon your shoulders, but it does mean you should alert other people to the possible risk. Go to your other friends, your at-risk friend's family, or a trusted teacher or counsellor. Just like your friend does not have to go through a difficult time alone, you do not need to try to save your friend on your own. If you fear your friend may attempt suicide, you should get some outside help and guidance from people who are best able to get your friend the help he/she really needs.