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Let’s talk about suicide

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.

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9 Comments

  1. Philip Nitschke Philip Nitschke 11 September 2014

    Assertion after assertion, but with little to no evidence. Claims like “it is not natural, and never healthy, to have any thought of wanting to die, or to prefer to be dead” do little more than feed the depression industry pathologising larger and larger areas of human behavior and appointing the medical profession (and the pharmacologists) as our saviours.
    In November a trial will take place in Darwin, Australia on rational suicide, the old ‘doctor knows best’ v. the right of any rational adult to dispose of their life whenever they want.

  2. Martin Young Martin Young 11 September 2014

    Philip

    You should have noticed I excluded those deciding to die due to irrecoverable quality of life issues from this argument.

    People recover from being suicidal as a consequence of depression. They then no longer want to die, and are relieved they did not.

    Are you advocating they should not be offered the chance of removal of the impulse towards such an irreversible and consequential action?

  3. Martin Young Martin Young 11 September 2014

    Dear Philip again

    “The right of any rational adult to dispose of their life whenever they want.”

    I don’t think that right should exist unconditionally. I can think of many situations that it must not. For example a single parent of young children has an obligation to try to support them surely? Or is the ‘right’ to suicide bigger than the ‘wrong’ of abandonment to the care of the state or taxpayer?

    Should a person sentenced to life imprisonment for a serious crime be entitled to commit suicide?

    You advocate very scary stuff.

  4. Sarah Sarah 12 September 2014

    I do not agree that suicidal ideation (the desire to be dead, or to escape dire circumstances) is a disease, or a mental illness which makes it a problem of the individual.

    In some instances, the desire to be dead is simply a desire to be removed from pain inflicted from the outside – e.g. daily humiliation in an unequal society, family squabbles, conflict at work, wars etc.

    I suggest that in those instances, it is a healthy response which is completely distinct from suicidal thoughts and a plan to take action to end life rather than to end or escape the situation.

    The word ‘depression’ is overused. Maybe we should consider finding a concept that more accuratelydistinguishes between psychological, medical and social triggers.

    B.t.w. how are levels of serotonin measured?

  5. Momma Cyndi Momma Cyndi 12 September 2014

    Thank you for this Martin.
    My daughter’s boyfriend is manic depressive (diagnosed) but refuses to take medication because it is ‘weakness’. Unfortunately, he grew up in a family which claimed that you must ‘pull yourself together’ and felt that anything that couldn’t be seen (or came with a fever) was not a ‘real’ sickness. Dealing with him during his depressed stages can be …. um …. tiring. Trying to surreptitiously control it without being able to resort to medication is just damn hindering awkward

    Having lived long enough to have gone to the (suicide) funerals of too many people who were the life and soul of the party, I find it sad that so few seem to take depression seriously. Whilst everyone probably goes through short periods of depression in their lives, it must be a terrible thing to live with for a prolonged period. A sustained erosion of the soul which eventually becomes too much to live with.

  6. Martin Young Martin Young 14 September 2014

    Spot on, Momma Cyndi

    Depression has an ‘image problem.’ It shouldn’t.

    My advice to your daughter is to, um, be careful where she invests her future. Depression becomes worse without treatment with age, not better. And the family always pays a price.

  7. Philip Nitschke Philip Nitschke 15 September 2014

    Martin,
    Re ” Should a person sentenced to life imprisonment for a serious crime be entitled to commit suicide?” my feeling is clearly ‘Yes’, although this is particularly the case where any chance of parole is denied, ie “life without parole” which is being seen more commonly in Western nations. Life imprisonment can be seen as state sanctioned torture, and if the state wants to go down this path and sanction torture, then at the very least it has an obligation to offer access to the means of a peaceful reliable death.

  8. Joan Elias Joan Elias 15 September 2014

    Dear Martin,

    Such wise words from you…but we have always admired and respected you, our specialist ENT.
    It has been good to find you now on Facebook, if we need your advice we know where to find you.

    Kind regards

    Joan and Morris

  9. Sarah Sarah 28 September 2014

    Eish Martinm I thought your headline ‘let’s talk about …’ was an invitation to engage. I did not realise it was a lecture rooted in immutable truth. I really am interested to know what evidence there is for ‘diagnosing’ low levels of serotonin. Is it a theory or an empirically verifiable fact?

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