Suicide and Depression

Even though suicide is the last thing I want to write or even think about, trying to understand its causes has been important in my recovery for two big reasons. One is learning about the differences between suicidal thinking, which many people with depression have, and the far less common factors that lead to actual suicide attempts.

The other is gaining greater insight about resilience and living well by understanding more about the self-perceptions that can lead people to take their own lives.

Suicidal thinking is often part of the experience of depression. I sometimes had those thoughts in the past, and they worried me, especially the idea of acting impulsively. I never came close to an attempt, but I was afraid that if depression got bad enough, I might some day feel so hopeless that I could try.

I was especially concerned because people I knew had killed themselves. Suicide and depression have never come together in my immediate family, but I’ve lost several friends to this terrible combination. I tried to imagine how they could do these things to themselves.

• A gifted teenager walks out of his house during one of the vicious fights his parents often had, goes to the barn near by and shoots himself with a rifle.
• A long-depressed and alcoholic man shuts off all contact with his friends and family, stops eating and tries to drink himself to death. Following a heart attack, he is found, brought to a hospital and revived, only to plead with his caregivers to let him die.
• A young man of many talents suffers from years of depression, then one day checks into a motel and kills himself with an overdose of antidepressants.
• A highly regarded attorney in his forties, who had dealt with depression and chronic pain for years, drives to a rural bridge at a state park, leaves his neatly folded clothes on the front seat of his car and jumps into the powerful currents of the river.
• A woman in her thirties, long distressed and unable to form a lasting relationship, takes an overdose of antidepressants, is rushed to the hospital where she has worked as a nurse and dies painfully after all attempts to save her fail.

Thomas Joiner is a psychologist who has devoted much of his career to studying suicide, partly because his father took his own life. His 2007 book, Why People Die by Suicide, is one of the few that attempts a comprehensive explanation of why people end their lives this way. I’m sure his ideas will be debated and tested by other researchers, but they make a lot of sense, especially in helping me understand the role of depression.

Although suicidal thinking can be part of depression, Joiner believes that this condition doesn’t by itself explain why people take their own lives. His studies have led him to focus on three specific factors that have to be present in addition to any mood disorder or sense of hopelessness. Here is the way he describes them.

• The acquired ability to enact lethal self-injury. Joiner emphasizes that it’s not an easy thing to commit violence on your own body. People who commit suicide usually have to acquire the ability to hurt themselves over time, often starting with milder forms of self-harm, like cutting their skin, starving their bodies or getting hurt in dangerous activities. Sometimes, they learn through unsuccessful suicide attempts and use gradually more lethal methods. The most basic instinct of all is to stay alive, and deliberately stifling that instinct takes practice and an increasing ability to tolerate pain and to overcome fear.
• Failed belongingness. The reasons why people set out on that path to begin with have to do with perceptions about their lives that make death appear the most desirable choice. One of these perceptions is that they will never be able to meet the basic human need for feeling related to others, either through individual relationships or a group identity. Some people feel they are invisible to others, that no one cares about them. This is not really true, but they come to believe that it is and that the failure to belong with anyone can never change.
• Perceived burdensomeness. People who turn to suicide believe that they have become so ineffective that they are a burden to everyone they care about. At first, they may think that they can’t do things right and fail to demonstrate competence and effectiveness, at least according to their own standards. When this goes beyond a sense of letting themselves down to the belief that they have let others down, then they may come to believe everyone would be better off without them. This is another terrible distortion of reality, perhaps most dramatically when a parent is sure that children would be better off if he were no longer alive.

It’s helpful to know that Joiner’s research and other studies are refining the understanding of specific motives to suicide. This work makes it a little easier to sense when suicidal thinking turns from a cause of concern, as it always must be, into a sign of imminent danger.

The most tragic aspect of suicide is that it is driven by perceptions that distort, sometimes even defy, the reality of connections and importance that people have to others. I keep thinking of the film Oslo, August 31st in which the central character seems to give himself one day to find out if he should stay alive.

In scene after scene, he shuts out all the evidence of his connections to people, his effectiveness in his work and the difference he can make in the lives of others. In the end, his tragic inner certainty that he is a failure and a burden wins out because he has shut his mind and feelings to any other interpretation of his life.

I doubt anyone knows how to get through to someone in that state of mind.

A sense of that inability to get through or make a difference seems to haunt Joiner himself, as a survivor of his father’s suicide. It’s an undercurrent in the book that comes through in passages like this one:

The main contribution of the book, I hope, is to provide people with an understanding of death by suicide … . My model emphasizes perceived burdensomeness and a perceived sense of low belongingness. It is painful for survivors to understand that their loved ones, lost to suicide, perceived these things about themselves; but it is helpful, I think, to understand that these were perceptions, not realities that should be blamed on survivors.

Thomas Joiner. Why People Die by Suicide (Kindle Locations 2401-2405). Kindle Edition.