What can we do about the increasing problem of Suicide

Suicide is a tragic event not just for the person who does it, but for all those left behind.     What is more tragic still is that the rates of death by suicide and by substance abuse, which I consider another version of suicide, are increasing rapidly, especially in the 10 – 24 year age group.  That’s right – in our young people!  Having dealt with too many parents who have lost a child to suicide, there is hardly anything more painful for them – a deep pain that never goes away.  It is not just the pain of unexpected loss of a child, but how it happened and all the self questioning and self blame – What did I miss? What did I do wrong? How could I have prevented this? Forty years of experience show that personal guilt is unwarranted, because parents do the very best they can with what they know and have learned and experienced.  Unfortunately these problems are not addressed anywhere close to adequately in this country or elsewhere, partly because of the way we stigmatize not only ‘mental illness’ – most of which is more appropriately termed ‘mental pain’ – and we even stigmatize emotions and talking about them and getting adequate help.  That help includes learning a lot of skills, not just taking pills!!!!!

Prevention is not something society or even the medical community thinks about in terms of emotions generally, not to mention for something  so ‘unexpected’.  I put that in quotes, because suicide kills 2 M people a year world wide,  40K in this country, plus another 60 K that get listed in the ‘accidental death’ category when they die from substance abuse but it wasn’t an overt suicide attempt. Hardly something we can consider unexpected when it kills as many people as the mosquitos that carry malaria and Zika and other diseases.  To me, substance abuse and some other addictive behaviors – like smoking – are a bit like playing Russian roulette and continuously pulling the trigger – you’ve got to know at some level there’s a serious risk.  Although Drug abuse is now getting some attention , part of the real issue for suicide and substance abuse is that they have been the ‘unspoken epidemic’.  People don’t take action to solve a problem when they don’t realize it exists.  Look at the attention that was given to Ebola in 2014 – it was a catastrophe getting worldwide attention and a push to really do something about it – and by comparison it only killed a total of about 14k people worldwide.  What if we would shine that same spotlight on the emotional pain that drives suicide and substance abuse (and other addictive behaviors) with an eye to prevention, which is the main thing that has truly made inroads in the medical field?  How much pain and suffering might we find a way to relieve – not just for the direct victims but for the even larger pool of family and friends left behind, who suffer so horribly.  In teens it has sometimes set of chains of ‘copycat’ suicides – as if one person doing it gave permission to some of those other hurting kids to do the same things. a

It is hard to work at preventing something when we don’t even realize it is a problem. But wait, there’s more.  We don’t pay attention to emotions and emotional distress generally – seeing emotions as something to be ashamed of and hide from – but when it doesn’t come out directly in suicide or substance abuse, it can come out in other ways – like creating or worsening physical illnesses – like cancer, heart disease, lung disease, liver disease, auto immune diseases and almost anything else you can think of.  In addition, many medical illnesses can have emotional distress as their presenting symptom – or could be the presenting symptom for emotional distress.  The numbers are getting worse in all these categories for all ages and it is time to start doing something more about it. To me that ‘something ‘ is very basic.  It is, ‘horror of horrors’ getting more open about and aware of our feelings, communicating and sharing them more and interacting more – directly, 1:1, personally with other human beings.

There have always been people who are depressed or distressed or found life unbearable for some reason – usually very valid reasons that will be exposed in therapy – things like emotional, physical and even sexual abuse –  which might happen in the family, from friends, or neighbors, or teachers or strangers – or might arise from guilt and shame we feel about something we have done and feel was so horrible we deserve to be punished.  It is fascinating that even though some kind of emotional issue, some kind of wound to our feelings – can cause great pain, and sometimes drives us to mental illness or self destructive behaviors – we stigmatize it when someone has any emotional pain – as if THEY are the ones at fault.  Now, of course, we also have the wonders of Pharmaceuticals –  it is a ‘chemical imbalance’ and a magic pill will “fix it”.   If that were accurate, then the $15 Billion worth  of psych pills every year just in this country would surely be moving the needle in the right direction.   However, those ‘chemical imbalances’ are mostly the result, not the cause, of the problem, just like sugar imbalance is the result of diabetes, not the cause of it, and the ‘treatment’ is a cover up of the problem, not a treatment for it. This problem has to heal ‘from the inside’, not just have a chemical ‘bandage’ put over it. Ironically, to do that, we have to be willing to open up, talk about those stigmatized emotions, and get outside help to express our feelings, so we  learn other ways to manage our thoughts and feelings and thus manage those injuries in ways that help heal from the inside rather than allow them to fester and grow.

So what, if anything, can any of us do for our children, our loved ones, ourselves, our friends or our coworkers to help with a problem which is so huge that suicide and drug abuse are only the ‘tip of the iceberg’.  First, most important, and probably toughest, is to recognize that feelings are not some dirty, nasty thing to be hidden away and avoided – they are the very core of what makes us human and allows us to relate to life, our fellow human beings, and everything thing else in our life space. Then comes the hard thing – talking about them without feeling ashamed or embarrassed – and realizing everyone doesn’t feel the same way about things and that is ok – sharing gives knowledge, understanding and power. Even better is when we realize ‘we are not alone’ – that there are other people who share similar feelings.  Part of  that sharing of feelings means providing time to do that.  In today’s world not only do people spend much less time talking face to face, or even ‘live’ on the telephone, families don’t sit down together at meals and talk and relate to each other – much less check in on each others feelings, activities, desires, plans, pains and so on. We are hypnotized by electronics and suffer from an ‘overconnected disconnect’.  That lack of connection also means we don’t notice when changes are happening that might indicate problems nor do people – especially our younger people – feel comfortable reaching out and saying they need someone to talk to.

It is so important, especially as a parent, but overall in relationships as well, to get to know our loved ones well enough to notice especially if something seems to be changing with them – whether good or bad – and talk about it. For kids, teens and young adults, there are very clear warning signs that parents should always tune in to.   Of course there are the big things like admitting they are depressed, or making a suicide attempt, or arriving home drunk or stoned, but there are more subtle things that should raise the alarm that it is time to sit down and have a more intense talk to help ward off problems.   This includes changes like a change in friends, attitude, school performance, activities, sleep patterns, health and similar things.   These can be subtle, or not so subtle signs, of any number of things – that can escalate into major problems.  The things causing it can be anything from a fight with a friend to a loss of a boyfriend or girlfriend or more important – critically important – issues – like drug use, or being abused by someone – whether by bullying, physical assault or sexual abuse –  all of which might not be talked about directly for a variety of reasons.  It could also be for less direct issues – like a classmate dying in a car wreck or by suicide, or being ill, or coping with illness or changes in the family, and a wide array of impactful changes. If you can’t get your loved one to talk to you when these changes start happening, get professional help.   Tune in to those same changes in yourself and get help if you need it – a therapist who can teach skills, not just someone who can dispense pills.

Early prevention is the very best strategy – and that includes doing a variety of educational things that help you better understand what is happening and why as well as some specific skills you can learn to help yourself and your loved ones.  I still learn by reading, listening to programs in my car, going to live programs to always learn more, and because none of us can ‘read the label from the inside’ – or see ourselves as others see us, it is also wise to learn from trusted others – friends, family, therapists and others – especially when something is bothering us.  Be sure however, to pick those people carefully.   With 7.5 Billion people in the world, there is no way you can ‘please’ everyone – not even our creator can do that – so we don’t stand a chance …….. When I got into therapy during psychiatry residency, with a whole department of people to choose from including a rare female, I chose very carefully, because so many people were really opposed to women professionals in those days, and I needed to spend my time learning to get better, not feel attacked for being a doctor in a day when very few women did that.  It was a great opportunity to get help from a very supportive, insightful, knowledgeable person who clearly had my back, so when something was said that I really didn’t like hearing – but needed to – I knew to listen and work on it.   All of us need people like that to turn to for that very intimate, private, emotional part of ourselves.

My wish for all of you this new year, is to allow yourselves to find people like that so you can open up in mutual sharing, and learn skills to diminish and manage any pain you are having, and to hopefully also prevent some – preferably most –  of those things from happening, because otherwise you have a 75% chance of some serious emotional pain in your life that will be very painful to handle alone and could turn into a significant emotional illness. You will find some helpful information on my website and more will be going out fairly often.   Judy    www.GoDrJudy.com