Over the last several weeks, various media outlets have reported stories of suicide. Just yesterday, Korean pop star Kim Jong-hyun was found unconscious and later died. Many believe his death should be deemed a suicide though this has yet to be confirmed. Reports state that he posted a suicide letter onto the Instagram account of a friend alluding to the unbearable pain of depression. Other news recounts the life of Ashawnty Davis, a 10-year-old girl from Colorado who hung herself and later died after a video of her confronting a bully surfaced on social media. Then there was Dr. Christopher Chad Dawson, a Texas surgeon struggling with severe depression who is reported to have shot and killed himself and his 2 young children. Encompassed in each name and every heartbreaking story is the brutality of depression and the seemingly incomprehensible tragedy of suicide.
But far too many women, men, and children know all too well about the savagery that is depression. They wrestle with the thoughts suicide, at times wishing for a permanent escape from its unyielding grip. Research shows that, despite prevalence of mental illness and availability of effective treatments, only 40% of adults and 50% of youth receive any mental health care.
There are a lot of misconceptions about suicide. In this post, I offer clarity and insight and hope to dispel some of the myths and mistruths that persist and impede people from getting the help they so desperately need and deserve.
1) Suicidal ideation or thoughts of suicide occur as part of many mental illnesses
Suicidal thoughts are a common symptom of mood disorders like Major Depressive Disorder and Bipolar Disorder but are seen with other psychiatric illnesses as well. Suicidal thoughts in and of themselves do not always necessitate immediate psychiatric hospitalization, but they do indicate an immediate need for a licensed mental health professional to evaluate the individual to assess the risk of harm, develop a safety plan, and further guide treatment.
2) Suicidality is on a spectrum
Suicidal thoughts can range from simply thoughts of suicide and feeling like a burden to others to contemplating different methods to end one's life but without expressed intent to active thoughts of suicide with a well-thought out plan, intent to act on that plan, and access to the means to carry out the plan. And these plans may or may not have been communicated to a loved one or health care provider. Some have what we call passive suicidal ideation where one may feel like a burden to their family and believe it would be easier to die but have no plan to end their life. Passive thoughts of suicide may be fleeting or occur frequently, but this person is not necessarily in need of emergent psychiatric hospitalization but does need urgent mental health treatment. Active suicidal ideation essentially refers to individuals with a suicide plan. These individuals are at extremely high risk of suicide and warrant immediate psychiatric hospitalization to ensure their safety and so that a psychiatrist can quickly develop a comprehensive plan (medications and therapy) to address their symptoms.
3) Suicidal thoughts can be acute or chronic
Some individuals find themselves in dire straits such as losing a job, the unexpected death of a loved one, facing legal charges, or learning of infidelity and then immediately decide they no longer wish to live. Under those circumstances, thoughts of suicide occur rapidly and that individual may act impulsively and end up seriously injured or dead. Then there are those who have chronic thoughts of suicide. This group often has struggled with thoughts of suicide for months or years and typically has an underlying psychiatric disorder but is not necessarily going to take steps to end their life. As mental health providers, we consider a multitude of risk factors when evaluating suicidality including acuity vs. chronicity of these thoughts, expressed and perceived intent, previous suicide attempts, access to guns, family history of suicide, history of mental illness, history of substance abuse, and medical illnesses.
4) Don't be afraid to ask someone about suicide
Asking someone about whether or not they are contemplating suicide does not mean that you are suggesting or encouraging them to kill themselves. Many may feel relieved at being given the opportunity to talk openly about their thoughts and feelings with someone who cares so ask if you are concerned and then help them get help.
5) Non-Suicidal Self Injury is not the same as suicide
Many individuals and especially adolescents engage in what we call non-suicidal self-injury (NSSI). Cutting is one of the most common types of NSSI, but other methods including burning and carving. Oftentimes these young people have no desire or intent to die but engage in physical acts to numb emotional pain. They still need an urgent psychiatric evaluation but may not require psychiatric hospitalization.
6) Pay attention to bullying in all forms
Bullying is quite troubling for many young people, especially cyberbullying through social media sites like Facebook and YouTube. Sadly, there are countless media reports of youth, children and teenagers, who attempt or complete suicide themselves because of bullying. I strongly urge all parents and caregivers to closely monitor your children and their social media accounts.
7) Take all threats of suicide seriously
Do not assume that someone is attention-seeking or trying to be manipulative when threatening suicide. Take all suicidal threats seriously. That kind of talk should be viewed as a cry for help. If someone believes the only way their needs can be meet is to threaten suicide, they are clearly in need of mental health services.
National Suicide Prevention Lifeline