Suicide and Depression

Infinity in a sunny landscape

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.

9 Responses to “Suicide and Depression”

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  1. Donna says:

    I have never felt like I was a burden on anyone. Even when my parents let me move back in with them when I was almost 40 because depression left me unable to take care of myself. Even when my ex-spouse tried to convince me he was ashamed of being married to a “mental case” as he put it. I always felt I had a place in the world, no matter what anyone else thought. But the “failed belongingness” and the “acquired ability”? Yes, those rang true.

    I attempted suicide 3 times over 20 yrs ago. The first time, I totally intended to die. The second time, I couldn’t remember taking the pills but definitely had done so. A friend found me and saved my life. The third time, I realized I couldn’t hold down a job anymore and couldn’t formulate a plan beyond that. I simply could not see or think of anything beyond the moment I would hand in my letter of resignation. There wasn’t something I dreaded in the future, I simply could not comprehend a future.

    The funny thing (if you can call it that) was that third time, I lived a block from my parents. I had already divorced, sold our house, and moved back to a familiar neighborhood where I’d grown up. And now, I see it was more a cry for help and not an intention to die. I called my mom and told her what I’d done. I had overdosed on several different prescription drugs. She said, “I’m busy. What do you expect me to do about it?” And she hung up. A little while later, my dad showed up. He told me he’d just gotten home from work and my mom asked him to come see about me. He sat down in a chair and said, “Why do you keep doing this? I don’t know what to do.”

    This lack of immediate compassion and the fact there was no overt outpouring of love from my own parents (I know now that’s what I was looking for and should have asked for with words) created such fury in me that rage took over. I told my Dad to go home, I would find a solution myself. He did, and I did. I called an ambulance, had my stomach pumped in the Emergency Room, raging all the while. In fact, I raged about it for years. And I think that rage is what saved my life. That’s what’s funny. I subconsciously wanted to appear pitiful and in need of a caregiver, and I got two sets of cold shoulder.

    I had never allowed myself to be angry about anything in my whole life. I buried all my emotions, as I’d been taught to do, and waited to be rescued. When I finally woke up to the fact I had personal agency and was in charge of whether I lived or died, I came to my own rescue. And I’ve been doing it ever since. If I’m going to have a place to live now, I have to attend to that. I have to pay the bills in order to have electricity. I have to buy my own groceries and decide what to eat. When I get tired, I have to make myself lie down. I have to get up in the morning and put my feet on the ground and start moving, like it or not.

    I have never had a serious suicidal thought since that day. And while I am still afraid of my emotions, I see they are not such a bad thing. They saved my life.

  2. Hopeful says:

    Thanks for this site. I can see there is a lot on this site that will help me. I lost a good job just before Christmas and it was due to lack of resilience. I’ve been down a long long time. I was working a lot and lost my temper with the boss. I made a mistake and just didn’t want to face the music from bosses who lack understanding. I quit. I was heavily suicidal for two weeks. I think some of your comments in your piece are right on the mark. “Failed Belongingness” has truly been my situation for a long time. I want to point out another factor that affects men. The unwritten rule is that you are never supposed to talk about depression. You are supposed to be a man and just buck up and take it. Sharing is supposed to be for sissies. I’m learning that ignoring a problem does not make it go away. I don’t need this pain inside that I’ve carried for dozens of years. Thanks to sites like this and commentary such as yours, I’m beginning to come out of it and I believe I’ll be better for it.

  3. cj says:

    Thank you for broaching this difficult topic. I’ve been at the edge of suicidal depression and am happy to be here. I love websites like this who help people! They provide much needed comfort on those sleepless nights of desperation.

    • John Folk-Williams says:

      Hi, cj –

      I’m so glad you can find some help here and at other websites when it’s most needed. Please stay in touch.

      Thanks for commenting.

      — John

  4. Evan says:

    Tony White has a good book Working With Suicidal Individuals available on Amazon or from here
    http://taaustralia.com.au/index.php?option=com_content&view=article&id=22:tony-white&catid=17:western-australia&Itemid=6

    His take is that the difference is those who take the suicide option have made one of several decisions – he lists them and what can work with responding to these decisions.

  5. Janet Singer says:

    This is a great post on a difficult subject and is sure to help many. Just seeing in print that the person committing suicide is dealing with grossly distorted thinking should ease some of the blame and guilt that loved ones inevitably, and wrongly, feel.

    • John Folk-Williams says:

      Thanks, Janet –

      The problem of the survivor feeling responsible in some way is a terrible, if understandable problem. I’m looking for more resources on dealing with the aftermath of suicide.

      John

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