“I Couldoun't take it anymore.”
I’ve heard countless patients make this confession in my clinic,
quietly, shamefully, tears swelling in their eyes. I wonder if Ms. Kate
Spade and Mr. Anthony Bourdain, in their final moments, alone in their
apartment and hotel room, respectively, felt the same way.
My formerly homeless and incarcerated patients have shared myriads of
stories, swallowed by their depths of despair, often manifesting as
anger, frustration, mental illness and substance use. From successful
lawyers and scientists to Marine Corps veterans to single mothers from
South America.
The mystery and tragedy of suicide is shrouded by an almost cosmic
connection between “us” and “them.” I did not know fashion mogul, Spade,
but I can relate to being a woman with a highly stressful career; and
as a daughter who loves her mother, I can barely fathom her
13-year-old’s emotional state. As a foodie with my own healthy spices
website, I always felt that Bourdain had my job. Who wouldn’t want to
travel the world, devouring delicious dishes? But like all of us, he had
his demons including a debt-ridden career washing dishes as well as a history of drug addiction. And both icons experienced depression and anxiety.
Suicide is not a stranger in my family. Over 35 years ago, my
mother’s cousin – Aunty Rita – killed herself in her early 30s, leaving
behind two young children, her twin brother and devastated parents.
While the details remain a mystery, we believe she lit herself on fire
in her home in Bombay. Not a day goes by that her mother and my mother
don’t fondly reminisce “Rita’s radiant smile” and irresistible laugh.
While an entire textbook can be written about suicide, I’d like to share five common misconceptions.
- “People who take their lives are weak-willed.” As a society, we continue to stigmatize people with suicidal thoughts or who have died by suicide. Socially discrediting someone during their darkest moments deepens their feelings of hopelessness. Many, though not all, experience depression which is a “brain disorder, not a choice, and affects people without regard for looks, wealth or fame,” according to Candida Fink, a psychiatrist in Westchester, NY. The World Health Organization reports ~800,000 suicide deaths worldwide each year. Breaking down the taboo of suicide and mental illness is key in prevention and treatment.
- It mostly affects people who are really struggling – poor, unemployed, homeless.” Suicide does not discriminate. According to the Centers for Disease Control and Prevention (CDC), suicide rates have increased by 30% nationwide since 1999. While depression was a known diagnosis in ~50% of cases, many other factors play a role. Financial strain, health issues, and stress at home and work were all contributing factors. Suicide is the 10th leading cause of death in the U.S. and one of only three on the rise (drug overdose and Alzheimer’s disease are the other two). Risk factors include prior suicide attempt, personal or family history of substance use or mental illness, chronic pain, family violence and guns at home.
- Suicide affects everyone equally.” This is a bit of
a trick. While suicide does impact people from all walks of life –
across races, nationalities, religions, professions – some groups are
disproportionately affected. Select at-risk groups (per CDC, NIMH):
- Men are more likely to die by suicide, but women are more likely to attempt suicide
- American Indians and Alaska Natives have the highest rate of suicide; non-Hispanic whites are 2nd
- 6% of students in Grades 9-12 reported at least one suicide attempt in the past 12 months; girls attempted twice as often as boys (11.6% vs. 5.5%), highest among Hispanic girls (15%) vs non-Hispanic white girls (9.8%; per 2015 Youth Risk Behaviors Survey)
- 29% of lesbian, gay or bisexual youth attempted suicide at least once in the past year vs. 6% of heterosexual youth (CDC); suicide rates are highest among transgender individuals (41% vs 4.6% among the general public; per American Foundation for Suicide Prevention (AFSP)
- According to the Department of Veterans Affairs (VA), ~20 veterans die by suicide daily; 7,400 vets took their lives in 2014 (or 18% of all suicides in the U.S.). Suicide prevention, along with opioid safety, remain top concerns at the VA.
- Physicians have the highest suicide rate among any professional group, with ~400 doctors taking their lives annually in the U.S. In New York City, two doctors and a 4th-year medical student died by suicide in the past five months
A doctor lays on the ground as several physicians stage suicides during an action to denounce the problem of physician burnout. February 18, 2014 in Paris, France. AFP PHOTO / KENZO TRIBOUILLARD (Photo credit should read KENZO TRIBOUILLARD/AFP/Getty Images)
- “There’s nothing I can do to prevent a suicide.” –
When a person takes his or her life, the people left behind often feel a
sense of helplessness, even guilt. When my aunt died, my mother and
other relatives felt they should have known; “we could have prevented
her death.” As difficult as it might be to accept, no one else can be
blamed for a loved one’s death by suicide. However, we can all take key
steps. The National Institute of Mental Health (NIMH) recommends the following:
- Ask: “Are you thinking about killing yourself?” Not easy, but studies show that asking does NOT increase the risk or suicide or suicidal thoughts.
- Be present: Listen to your colleague or loved one. Observe their body language.
- Safety: Minimize a suicidal individual’s access to lethal items (e.g. guns, knives, razor blades, stockpiled pills) or places (bridge, highway). Again, not always simple, but removing access to dangerous weapons/locations can be lifesaving. Of note, firearms are the most common method of suicide (with or without mental health issues; source: CDC), accounting for 51% of all suicides in 2016 (AFSP).
- Connection: Stay in touch with someone after a crisis or recent hospital release. Suicide deaths decrease when we follow up.
Over 7000 veterans died by suicide in 2014. Manila American Cemetery in Fort Bonifacio, Taguig, Philippines, May 25, 2014. Photo: Ezra Acayan/NurPhoto (Photo by NurPhoto/Corbis via Getty Images)
- “I have nowhere to go.” The sense of hopelessness can be profoundly overwhelming. If you or a loved one needs help, please call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) where trained counselors are available 24/7, seven days a week. Other numbers to save in your smartphone: a close friend or relative; the Crisis Text Line, 741741; and the local police department. National Alliance of Mental Illness (NAMI), Substance Abuse and Mental Health Services Administration (SAMHSA), NIMH and Zero Suicide also offer excellent free online resources.
When I reflect on this past week, I am overcome with many emotions:
sadness, confusion, loss. But I also remind myself to replace my biases
patience, kindness and sincerity. I think we can all listen, without
judgement, to our colleague who’s going through a divorce; our uncle
who’s depressed about his wife’s dementia; our neighbor who wears a
turban and smells “like curry.” Ask yourself, “What can I say or do to
ease someone’s burden?” Our gestures needn’t be grand. Smile at fellow
passengers on the subway. Hold a door open. Offer to carry a stranger’s
grocery bag.
And if YOU are feeling helpless, alone and/or have thoughts of
hurting yourself, please know that you are NOT ALONE. I promise you,
someone will listen. Reach out to someone you know and trust, or to a
trained professional. Your life has VALUE.
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