Hannah Goes Fishing

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The Culture of Suicide

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This is not an easy post to write due to the unpleasant subject matter and my own personal experiences with suicide.  However, my home town is current in the throes of a teenage suicide, and Alaska has a higher suicide rate (nearly twice the average) of anywhere in America.  Thus, I feel it’s an important topic that warrants some consideration. Though there are many cultural variations on suicide,  I’m going to speak about it from an American and specifically Alaskan perspective.

I’d like to preface my comments by disclosing that I am a trained suicide and crisis intervention specialist, and have worked on and off for several years at a suicide and crisis intervention hotline. My experiences with suicide are largely through that employment, though I have had a suicide within my family that was especially heartbreaking.

The word suicide derives from the Latin suicidium, from sui caedere, or “to kill oneself” (Wikipedia).  Sometimes there is confusion between euthanasia and suicide.  Is there a difference?  I had someone describe it this way:

Euthanasia, sometimes referred to as physician-assisted suicide (from Greek meaning “good death”), is the intentioned end of the dying process.  Suicide is the end to living.  I like this nuanced difference, because it demonstrates the intent of death in each instance.

Suicide is, for many people, frightening and difficult to consider.  Why would someone intentionally end their own life?  There are so many stigmas surrounding taking one’s own life that it can be difficult to understand the mindset of someone who would choose death over life.  Suicide is thought of as a sin; as a selfish choice; as a cry for help; as an attention seeking ploy; as the choice of a troubled or sick mind.  Note that none of these brands are particularly positive – one of the reasons that it’s very difficult for people considering suicide to reach out for help.  Even in the field of emergency medicine, I hear first responders with attitudes that reflect a total disconnect from what suicide is:

“If they want to die, then we should just let ’em.”
“There’s nothing we can do to help them.”

“They just want attention.”

As a first responder and suicide interventionist, I want to point out what a dangerous mindset that can be.  In my experience, there are two types of people who consider suicide, and usually only one type of person that you’ll encounter.  The first type is the person who has already decided that death is their only choice. This person is unlikely to ask for help, to call a crisis hotline, or to tell anyone about their plans.  They will simply commit.

This type of person is especially heartbreaking because they may have never offered the opportunity for anyone to help them.  Friends and family of this person may feel that they never saw any signs, or will be troubled by thoughts of, “What could I have done differently?”  Mental illness, extreme depression or other traumatizing life events may lead someone to commit suicide in this manner.

The second type of person is the type that one hears from on a suicide hotline or who calls 911.  If we consider the internal dialogue of this person, we would hear two voices.  One voices wants desperately to end the pain in their life (physical, emotional, mental, or otherwise), and perceives death to be the only way out.  The other voice wants desperately to live, but is forgetting how to do so.  This is the kind of person who reaches out to someone, though their method of doing so many be difficult to notice.  This is the person who exhibits classic signs of intent to commit:

– giving away possessions
– making comments about ending life or no longer “being around”
– changes in regular routine (loss of appetite, sadness or depression, etc.)
– substance abuse
– withdrawal from normal life activities, friends, or family
– planning for end of life (writing a will, etc.)
– impulsive activities abnormal for that person

This list is certainly not exhaustive, and it puts friends and family in the position of being the most likely people to notice changes in a loved one.  This is where it’s important to understand the mindset of someone contemplating suicide.  These behaviors may, in fact, be a plea for attention, but not for selfish reasons.  They are asking for help.  They are asking for someone to notice their pain and suffering and offer them a hand.  Most importantly, this is a person who wants to be helped; they just may not know how to ask for it.

This can be a very frightening prospect for the person who notices these behaviors.  Suicide, even today, is a very taboo topic in our culture.  What do you do with someone who is suicidal?  Do you cal the police?  Do you just ignore it?  What if I don’t want to deal with a suicidal person?  These are tough questions that an individual must answer in deciding how to proceed.  I’ve provided here some guidelines in helping get through these choices and find the appropriate help for the person in need.

First, never ignore a plea for help, whatever form it may present itself in.  Acknowledge that this person is considering ending their own life.  Acknowledge that they have come to you for help, or that you are the person who has noticed the signs of suicide.  Confront that person compassionately, or tell someone who will.  Suicide is a scary thing to think about, even for the person considering it.  It’s important to confront with kindness, but to be direct. There are three questions that are important to ask as directly as possible.

1. Are you considering suicide/killing yourself/ending your own life?
2. Do you have a plan to kill yourself?  A plan means a method of killing themselves (a gun, overdose, cutting with a blade, etc.).
3. Do you know when you would kill yourself? Try to identify if the suicidal person has decided when and/or where they would end their life.

A “yes” answer to any of these questions is a serious red flag and should be treated with respect and sincerity.

Second, don’t go it alone.  Chances are you are not equipped to help a suicidal person beyond that first intervention (see above).  Immediately refer that person to a health care professional or suicide hotline (they can call Careline, Alaska’s hotline at 1-907-452-4357 or text “4help” to 839863).  Make them promise you that they won’t hurt themselves in any way until they seek some kind of help.  Help them make the appointment to see someone.  Do not allow them to make casual promises to “do something.”  Make them swear up and down to you that they will seek help, and make a specific plan together as to what they will do.  This may sound harsh, but it’s a very effective way of obligating that person to another task in life before attempting death.

Third, follow up this process with self-care.  Dealing with a suicidal person can be unnerving at best and emotionally traumatizing at worst.  Seek out activities and people who can help you process this experience.  Call Careline yourself and talk through what you’ve just experienced.  Suicide is sneaky in that thoughts of a suicidal experience can fester and turn ugly inside of us if we don’t address it head on.

In addition to knowing these steps, it’s important to also know your resources.  Careline is a great resource as it’s available 24/7 every day of the year (even holidays).  However, there is also a process called Title 47, which allows a concerned citizen to ask for a crisis intervention for someone in need.  Click the link to read the statute and learn more about how to implement that process.  It’s important to never ignore signs that someone needs help.  Ever.

Finally, it’s important to understand suicide as a phenomenon.  Suicide is sometimes described as being “contagious” due to the fact that is can occur in clusters.  This is a common occurrence in Alaskan villages and small communities, particularly where substance abuse issues are common and rates of depression or other mental illness are high.  It can happen that a person will commit suicide, and in the process inspire others with similar thoughts of self-harm to also take the next step of committing. This is why it’s important to take every case of suicide or threats of suicide seriously and seek help; you never know who else may be hurt by their action.

Suicide in not rare, nor should it carry such a serious cultural taboo.  Over 1 million (yes, million) people commit suicide in the United States each year. It is the 14th most common cause of death in our nation.  According to the Alaska Statewide Suicide Prevention Council:

– In 2007, Alaska’s rate of suicide was 21.8 suicides per 100,000 people.  the rate of suicide among Alaska Native peoples was 35.1 per 100,000 people.
– Alaska had 1,369 suicides between 2000 and 2009.
– Alaska has an average of 136 deaths by suicide each year.  There is an average of 2.6 suicides in Alaska every week.
– At least one suicide occurred in 176 Alaskan communities between 2000 and 2009.
– About 78% of suicides in Alaska are committed by men.
Youth who are exposed to suicide or suicidal behaviors are more at-risk for attempting suicide.
More than 90% of people who die by suicide have depression or another diagnosable, treatable mental or substance abuse disorder.

I hope you are shocked by these numbers.  I am.  We worry a lot about violence and homicide in our culture, but did you know that suicides outnumbers homicides by a three-to-two margin each year?  Seriously.  It’s time we got serious about this.

A final argument to consider: Why should we care about suicidal people?  If they want to die, let them die.

I really detest this argument because I feel it undermines the value of one person’s life not only to themselves, but to others.  If for no other reason, you should intervene suicide because it is detrimental to families, relationships, and communities.  A single suicide can rip apart the fabric of trust, safety, and confidence in a home or town.  It’s happening right now in my home town, and it’s absolutely heartbreaking.  Death is immeasurably hard to begin with.  Death of someone young, of someone who was deeply loved, of someone who otherwise had no earthly reason to not continue living, is soul rendering, crushing, and numbing to those who cared for them (and even those who did not).  So if for no other reason, intervene to save your community and their family that pain.

A last note:

If you found this blog post because you yourself are considering ending your life or hurting yourself, please stop and seek help.  Promise me you’ll seek help.  Call Careline (even if you’re not from Alaska, but especially if you are).  Call the national hotline 1-800-273-TALK (8255).  Call someone you trust.  Just do something. Do not choose death if even a fraction of you wants to choose life.

Thank you for having the courage to read this post.

 

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