Let's talk about suicide - Thought Leader

Today is World Suicide Prevention Day.

About five years ago, as my family and parents and siblings celebrated Christmas Day together, we received a call from the UK. My uncle, my father’s twin brother, a larger-than-life man in his mid-seventies, with a large family of his own, and ostensibly in good health at the time, had committed suicide.

We have no idea why. It was an out-of-the-blue event. Irreversible, permanent. It left scars on us all. I cannot imagine the effect on my cousins and their own children who were gathered there together at the time, and have to relive the immediate memories every Christmas.

Why would anyone want to kill him- or herself?

Let’s take out of the discussion the religious and political fanatics, suicide bombers, militants who believe their deaths will take them to paradise with special reward for their actions. Also, those who sacrifice their own lives in the service of others or for political ideals — soldiers, policemen, rescuers, heroes — these people do not want to die, but accept the risks as a part of their jobs. Let’s also remove the euthanasia argument — people whose lives are so compromised that death offers a blessed release.

Let’s talk about the seemingly healthy, fit people who, out of the blue, kill themselves.

It is not natural, and never healthy, to have any thought of wanting to die, or to prefer to be dead. Biologically humans are just not wired that way. The natural condition is to strive towards a better state, or a better situation. Wanting to die, to escape life altogether, is a symptom of a disease.

A disease called depression.

Depression is a disease just as much as diabetes is a disease. In the latter it is either a lack of or a resistance to insulin that is the cause. In depression the lack, among others, is in a feel-good chemical in our brains called serotonin that is responsible for transmitting nerve signals between different areas that affect all actions of our brain, including our mood.

Too little serotonin in various areas and the brain simply does not function properly. Raising the availability of serotonin improves the mood.

Depression manifests in various ways in different people. There is a marked variation between men and women. Many people do not even know they are depressed, blaming the way they feel on being “run down” or “burnt out”. An “absence of joy” otherwise known as anhedonia may be the earliest sign. Depression wrecks relationships and careers.

People with depression are not “weak”. Depression affects primarily high-functioning people — doctors, lawyers, business executives, actors, musicians, highly productive people. There is major alarm in the US at the high numbers of doctors committing suicide.

Depression carries an unfortunate stigma for a medical illness that is relatively easily treated. Insurance companies heavily weigh those who admit to depression at any stage in their lives. Most commercial and civilian pilots, the high-functioning type of person prone to depression, are not allowed to fly while taking antidepressants, due to a perception that the side-effects would inhibit the pilot’s ability to fly. Consider on your next flight that your pilot may be heavily depressed, unmedicated and suicidal, as is one theory in the Malaysian Airline Flight 370 mystery?

Being suicidal, having suicidal thoughts even without the intention to carry suicide out, is never normal. As a symptom, “suicidal ideation” is a sign of depression and evidence that the person’s brain chemistry is out of kilter and needs to be corrected.

Most suicidal people tell someone about their thoughts in some form — in person, or a message of some sort. This message should never be ignored, with a response directed at getting that person to help, be that help a family member, doctor, psychologist or even a suicide help line. An opportunity missed here may cost that person’s life.

To be suicidal is to be in a unique condition that has to be experienced to be understood. For some with severe depression ordinary living becomes such a massive burden that the desire to escape it is overwhelming. While the act itself leaves others devastated, deeming suicide “selfish” does no one any good, creates further stigma, and discourages those suffering from getting the help they need.

Treatment for depression involves support from family, friends, doctors, psychologists and psychiatrists, and includes counselling, psychotherapy, exercise, general lifestyle changes and medication.

Medication for depression is highly effective, but needs to be used under medical supervision. One significant risk, particularly in young people with severe depression, is that the medication may lead to an improvement of motivation, motivating the person with suicidal thoughts to take action. Family and medical support need to be especially aware of this situation.

Any suicide represents a failure, not primarily that of the victim, but of the friends, family and medical providers to intervene and support the depressed person through an illness that has a cure. We all need to be able to talk about and discuss these feelings, to talk about depression, to remove the stigma, so that people are free to communicate how they feel without embarrassment.

As my family learnt with a shock, suicide can strike anyone. It’s up to us all to prevent suicide, by opening up and talking about depression before suicide strikes. Let’s talk before other lives are lost unnecessarily.