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Addressing the Stigma

"Survivors face many challenges, including the attribution of "selfishness" to the deceased by those who lack understanding."

by Ronnie Walker MS, LCPC

A while back, a post on the forum caught my attention.  The gentleman who wrote it was angry at his “uncle by marriage” who had killed himself two days earlier.  In grappling with the death of his uncle, the poster expressed several of the most clichéd and negative assumptions about individuals who end their lives.  Here is his post: 

“Two days ago, my uncle by marriage committed suicide. I wasn't that close to him, but he always treated me with consideration. … He was a 62-year old farmer, a pillar of church and community, and the wife found him hung in the barn. …. No one thought he had any problems. No sign of depression. No note.

 ... I have some mixed feelings. I believe it was his choice to kill himself. Nobody knows how much pain the guy was in, and if that was his solution, then that solution was his to implement. On the other hand, I get the feeling it was like he was saying '**** ***' to one and all. Because of that, I say to him '**** *** right back at ya. You didn't get to me with what you did and any suffering you incur because of it is rightly yours and has no claim on me.'

He had a wife, kids and grandchildren.  I think it was a rotten thing for him to do this … It's like he's put the reputation of his family, heretofore a family the whole community looked up to, into question. In a way, it let the town down to.  He chose this route. -- 'You're dead now fellow.  How's that workin' for you?'"

When I first read the post, it took my breath away.  I was startled by the lack of compassion for the deceased and the belief system that informed the writer.  And I was concerned about the impact the post might have on other members of the forum.  But the poster had invited “other opinions and observations” in his closing paragraph and “wished everyone on the forum well” … so in I headed in with a response. Here is my response:

On Translating Science into Practice

 

Dr. Lanny Berman "...it is my belief that the best of research must translate into policy."

by Lanny Berman, Ph.D., ABPP

The World Health Organization states on its website that “not all suicides can be prevented, but a majority can”, and specifies a number of measures that can be taken at community and national levels to reduce risk. Prominent among these measures is “Reducing access to the means of suicide.”

Few suicidologists and specialists in public health suicide prevention would dispute the evidence that means restriction efforts save lives (Mann et al, 2005). Moreover, few would dispute the evidence that, although method substitution does occur, only a relatively small proportion of individuals intend on using one method, but thwarted from access to that method, go on to die by suicide from an alternative method. In the United States, where suicides by firearm predominate, ecological evidence overwhelmingly supports a preventative approach to remove firearms from easy access, to safely secure firearms, to engage firearm locking mechanisms, etc. (Hemmenway, 2006). Numerous examples, worldwide, have demonstrated the effectiveness of bridge barriers in preventing suicidal jumps from these structures (Beautrais, 2007). IASP, in conjunction with the WHO and with funding from Syngenta, has produced promising results from pilot studies of locked pesticide storage boxes on farms in Sri Lanka immediately accessible paracetamol pills has demonstrated reduced deaths from intentional paracetamol poisoning (Hawton et al, 2001); and the coal gas story in the UK (Kreitman, 1976) is infamous in defining that reduced access to highly lethal methods of suicide is effective.

The National Military Family Bereavement Study is Recruiting Participants

While the number of soldiers who die on active duty status continues to climb, there is little we know about helping the loved ones left behind to cope with the grief and anguish of the grief journey, particularly those coping with a military death. A congressionally directed medical research study will look at how families cope with the death of active duty soldier to identify the unique factors of a military death and how that impacts the surviving families.

You are eligible for the study if:

*Your loved one died by any circumstance of death while on active duty status since September 11, 2001, in any branch of the US Military (Active, Guard, and Reserve Components of the Army, Navy, Air Force, Marines, and Coast Guard).

* You are the parent (adoptive, biological, custodial)/stepparent; spouse/ex-spouse/adult partner; minor/adult child; biological/step-sibling of the active duty soldier who died.

There are multiple phases of this study that one can participate in. The first phase is an online questionnaire and the second phase includes multiple family interviews over several years with at least two members of the family. To participate in the family interviews, you must complete the online questionnaire first. A series of focus groups will take place in various parts of the country and at events where enough participants can be grouped together by loss. Finally, a saliva DNA test will be administered to any participants interested in the biological aspects of grief.

The research is funded through the Center for the Study of Traumatic Death, Department of Psychiatry, Uniformed Services University in Bethesda, Maryland. Community partners include the Tragedy Assistance Program (TAPS) for Survivors and other military-related support organizations.

If you or someone you know is interested in taking part in this study, please visit the web site, www.militarysurvivorstudy.org and submit an email asking for more information. Your email will be routed to a field researcher in the area of the country where you live.

The Masculine or Instrumental Style of Grieving

By Debra Stang, LCSW, LMSW

The scenario plays itself out hundreds of times each year. A mother and a father lose a child to suicide. The mother plunges into deep, soul-shaking grief. The father remains stoic as he signs the cremation paperwork, selects an urn, and fields messages of support from other family members and from friends. In fact, most of those words of condolence are probably directed towards the mother, since the father doesn't seem in need of comfort.

A few days later, he is back at work. If colleagues notice any change at all, they may observe the father is more quiet and aloof than usual, and perhaps gets angry faster and with less provocation than usual.

Two weeks after the death of the child, while the mother is still all but confined to her room, the father goes on a camping trip with his best friend.

Six months later, sitting on a couch in a marriage counselor's office, the mother explains why she is contemplating divorce. "He's just so cold. Do you know he went camping less than two weeks after Michael died? It's like he doesn't even care."

Why? Impulsive Suicide

By Debra Stang, LCSW, LMSW

If you've spent time on the Alliance of Hope for Suicide Survivors community forum, you've probably seen posts about two types of suicides. The first is the type that most people recognize. The person who completed suicide had a history of mental illness, had made prior attempts, and exhibited many of the so-called warning signs.

The second type that people don't know as much about is the impulsive suicide. The person who completes this type of suicide may not have put any thought into the matter at all. There is usually no history of depression and no warning signs that can be identified, even in retrospect.

Impulsive suicides usually involve a triggering event--which others may not even recognize as significant--and immediate access to a way to end one's own life. If there is no immediate access to a suicide method, the suicidal thoughts may pass without causing harm.

For instance, in the 1950s, most English ovens were heated with gas derived from coal, which produced lethal amounts of carbon monoxide. Over 2500 people every year committed suicide by leaning into the oven and inhaling the poisonous fumes.

As more ovens converted to using the far less dangerous natural gas, the rate of carbon monoxide-related suicides in England dropped, which was expected. What was not expected was that the entire suicide rate in the country dropped by more than 33%. It remained at the lower level.

Experts finally came to the conclusion that, denied a quick, painless, and highly lethal device, many people with impulsive suicidal feelings dealt with the triggering event in another, less destructive, way.

In the News: Researchers Work on Blood Tests for Depression

According to a study published in the April 17, 2012 issue of Translational Psychiatry, researchers are close to finding a blood test that could diagnose major depression in teenagers. The tests would also differentiate between different types of depression, so that treatment could be more closely tailored to the individual's needs.

Researchers are also hopeful that a physical test for depression will help people understand that depression is a medical condition, just like diabetes or high cholesterol, and reduce some of the stigma that still surrounds any kind of mental health problem.

Read the entire story on CBSNews.com.

Suicide Rates Up, Mental Health Services Down

According to a March 4, 2012 article published on PsyWeb.com, the number of suicides in the United States is on the rise. The year 2009 saw 36,909 official suicide deaths, a 2.4% increase from 2008. During 2009, 8.3 million adults struggled with suicidal thoughts and over a million actually made a suicide attempt.

The Centers for Disease Control (CDC) revealed that about 13% of the 2009 suicides could be traced back to economic issues such as job loss or overwhelming debt.

Although official statistics for more recent years have not been released, the National Suicide Prevention Lifeline reported a 14% increase in the number of calls it received between 2010 and 2012.

These numbers come at a hard time for Americans, since cuts to federal and state budgets have defunded many mental health centers geared towards helping lower income clients and forced others to significantly cut back on the services they offer.   

Why? Terminal Mental Illness

By Debra Stang

My friend Julia was born in 1957 to a teenage mother. Her early years were a nightmare of abuse and neglect. She was not quite 15 when she first attempted suicide.

She survived the attempt, left home, and became the first person in her family to ever attend college. Still, she suffered crippling bouts of depression. Throughout the next thirty years, she sought treatment through counseling, medication, religion, holistic therapies, and psychiatric hospitalization.

None of it helped. By the time she was in her late 40s, she was plagued with physical and financial problems as well as clinical depression. She averaged one or two serious suicide attempts every year.

A few days after her 52nd birthday, Julia committed suicide with an overdose of muscle relaxants. At the time of her death, she was taking antidepressants and was under the care of both a psychiatrist and a psychologist.

Severe Mental Illness is Not Always Treatable

Despite the information provided in mental health public service announcements and advertisements for various psychiatric medications, severe mental illness does not always respond to treatment. Consider the following facts taken from the website of StopASuicide.org.:

• 90% of people who complete suicide have one or more diagnosable psychiatric disorders
• People with a mood disorder such as clinical depression or bipolar disorder are 12 to 20 times more likely than the general population to take their own lives.
• People with an anxiety disorder are 6 to 10 times more likely than the general population to take their own lives.
• Of the people who complete suicide, 20% to 40% have made one or more previous attempts
• Around 30% of the people who complete suicide are receiving psychiatric treatment at the time of their deaths.

In the News: Deep Brain Stimulation (DBS)

Deep brain stimulation (DBS) has been successfully used to treat Parkinson's disease and other neurological disorders. Now researchers believe it may benefit people with treatment-resistant depression as well.

A study published in the Archives of General Psychiatry in January of 2012 followed ten people with major depressive disorder and seven people with bipolar disorder who received DBS. Of the 17 patients, 12 remained in the study for 24 months.

At the two year mark, 11 of those 12 people reported that they were experiencing either no depressive symptoms or very minor depressive symptoms. Just as significantly, none of the people who achieved remission experienced a relapse or reoccurrence of symptoms.

DBS is not a miracle cure--in fact, the Food and Drug Administration in the United States has not even approved it as a treatment for depression. Even if further research confirms that it is effective, its invasive nature will probably ensure that it remains a treatment of last resort. But for people who suffer from intractable depression, a last resort is better than no resort at all.

Read More about DBS

"Brain Electrodes Fix Depression Long Term" in Nature International Weekly Journal of Science

"Deep Brain Stimulation for Major Depression: Miracle Therapy or Just Another Treatment?" in Scientific American

 

In the News: Uncovering a Possible Suicide Gene

By Debra Stang

Mental health professionals have long suspected that there is a genetic risk factor for suicide. Now, a study conducted by Dr. John Mann at the New York State Psychiatric Institute (as reported by The Guardian) may have isolated at least one suicide gene.

Dr. Mann reported running genetic tests on 154 depressed people who had attempted suicide and 258 depressed people who had not. The subjects who had attempted suicide were more likely to have variant copies of the gene RSG2.

Mann believes that genetic factors may explain while some people with depression attempt and complete suicide while the majority do not. He also states that continuing to pursue the genetics of suicide may, one day, allow clinicians to identify depressed patients with a higher risk of suicide and manage their treatment plans accordingly.