6. Suicide

Elaine Sugden

  • Book Chapter

SUICIDE

Elaine Sugden

The intentional taking of one’s life is a tragic event, an act of despair. Suicide is a desperate attempt to escape suffering that has become unbearable. You can’t make a person suicidal by showing that you care. Talking with a potential victim can make a difference. Talking with a bereaved survivor is essential.

‘Most people who commit suicide don’t want to die – they just want to stop hurting.’ Harvard Health Publications 1

Talking about the possibility of suicide is important

Engaging with someone who is severely depressed and/or talking about death can be very worthwhile.

The evidence suggests that bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do, and can be a relief to the person concerned.2 A way of doing this could be with a sympathetic question: ‘Have you ever thought of ending it all?’ or, ‘Are you having thoughts of suicide?’ You are not putting ideas in their head, you are showing that you are concerned, that you take them seriously, and that it’s OK for them to share their pain with you.

Be calm and non-judgmental; reassure the person that there is help. Encourage the person to tell their doctor, a therapist, or another adult they trust. Sometimes it might be necessary for you to inform helpful authorities. (See NHS choices website below). For this reason, it is important not to let yourself be sworn to secrecy.

People do better with good friends with whom they can share their anxieties and despair. It is good to talk.

Some will prefer to talk to The Samaritans: 'People talk to us anytime they like, in their own way, and off the record

– about whatever’s getting to them. You don’t have to be suicidal.'3

But many people who commit suicide give no warning to anyone that they are thinking about it. They know that if they are to be successful, they must keep their plans to themselves.

The Harvard Medical School website gives this helpful list of things that can put an individual at a higher risk for suicide in the short term:

• an episode of depression, psychosis or anxiety

• a significant loss, such as the death of a partner or the

loss of a job

• a personal crisis or life stress, especially one that increases a sense of isolation or leads to a loss of self- esteem, such as a breakup or divorce

• loss of social support, for example, because of a move or when a close friend relocates

• an illness or medication that triggers a change in mood

But the website goes on to say: ‘We all face crises or problems like these. One difference is that among individuals who take their own lives, these situations cause such pain or hopelessness they can’t see any other way out.’4

Suicide is not uncommon

Every 85 minutes in the UK, someone dies from suicide. In 2013, 6708 suicides were recorded in UK and Ireland.5 In 2013, suicide was the leading cause of death in England and Wales for men aged between 20 and 49 years of age. The highest suicide rate was in men in the 45 to 59-year age range. The incidence in men was over three times more than that in women.6 The highest incidence was in those with mental health problems and, particularly, in the first few months after diagnosis. Admission to hospital, intended to provide a safe environment, might reduce but does not eliminate the risk.

‘One characteristic that emerges in almost all studies is a desperate sense of hopelessness in the suicidal. The hopelessness may puzzle and distress friends and family as inexplicable – but is nonetheless dark, black, painful and (in the end) unendurable in the sufferer.’ Mike Parsons, ‘Suicide and the Church’ 7

Efforts to reduce the risk

Most suicide attempts are planned within an hour of the event, so that removal of obvious methods would seem sensible. Nationally, the removal of coal gas, carbon monoxide from car exhausts and paracetamol sold in large quantities did result in a drop in incidence of suicide by each of these means, though substitution by other methods has occurred.8

Antidepressants in those with known depression and suicidal thoughts can be useful, but some of those depressed are fearful of taking antidepressants, whilst a significant proportion stop taking medication some time before taking their own life.

The bereaved survivors

For each of the over 6000 people who took their own life in 2013, there was at least one and often several bereft survivors.

One such survivor, S, tells the story of the youngest of his three brothers who was in his early fifties when, over fifteen years ago, he took his own life. This brother had a challenging childhood illness which was kept secret outside the family. He developed into a passionate and deeply sensitive person, ever eager to help those around him. After leaving school, he did a few different jobs and then joined the family business, which deteriorated and closed down when his father retired. He married and later adopted three children with a history of abuse and who, in their late teens got into various scrapes with the police. He and his wife took on another business, which failed, and they separated. Latterly, he partnered a single mother with three children.

Against legal advice, he bought a house in their joint names a few months before this relationship failed. He realised she had been deceiving him and that he had lost much of his money; feeling that he had made a mess of things he committed a carefully planned suicide, leaving letters to his lover, his adult children and others. His instructions for a service of remembrance celebrated the Christian faith he had never left.

This is what the bereaved brother S wrote recently: 'To begin with I thought I will find out all that had happened; I will uncover the truth. But quickly we realised it was impossible to know all the circumstances. Some good friends of his wrote a detailed and helpful account of their dealings with him in his last few months. But there were large areas of obscurity. Our parents were sad but did not want to hear unwelcome detail; our mother preferred to think he had died of natural causes, despite clear evidence to the contrary.

We could have held a family conference with some of his friends to try to learn more. But we all knew different bits of the story.'

The question ‘Why?’ is on the lips and in the mindsof family, friends and acquaintances after every death by suicide.

They have forced their goodbye on you, a goodbye you have not wanted and cannot now undo. For that, you have only the ringing, unanswerable whys.' 9

The most common overriding emotion for those left behind is guilt. ‘If only I had – noticed something was wrong/ been there/not said those cross words. ’ Guilt under these circumstances is almost always unjustified, but acutely felt.

‘I wonder if I should have said something. He mentioned a while before he died that he was having a hard time and I didn’t tell anyone, maybe I should have. Maybe he would still be alive if I’d said something. People say it wasn’t my fault but I can’t help thinking I should have been able to help him.’ Sister of 18-year-old 10

Some are angry at, or feel rejected by, the one who took their own life. Blame is common: God, the employer, the other parent. Those who find themselves in the firing line need to soak up the anger and blame rather than retaliate. The bereaved are hurting deeply. They need someone to talk to, who will listen to them and who will try to understand what they might be feeling. They need friends and perhaps to be directed to some useful resources.

Ben, just short of 20 years, had been troubled with schizophrenia for almost four years, during which he had self-harmed. He was thought to be doing rather better when he went out on a bike ride and didn’t return. His parents told me:

‘The presence of people was helpful, just being there, listening, whether to speech or in silence holding hands. (It would be OK to ask the suffering person whether or not they want you to stay). We didn’t feel they were intruding but were glad to have interest and care. Don’t be frightened of tears either in yourself or the one/s you are trying to express care for. Be prepared to weep with them.’

Men and women often react differently, but it is important to allow grief to be expressed.

Hector was 21 when, in 2011, he took his own life. His father, from experience, said: ‘Wives and partners often wish for men to be in touch with their feminine side so that they understand how they feel. But the minute a man bursts into tears and appears to “lose control” or be less of a man, they are truly shocked and don’t really like it.’  Jamie Doward, The Observer News, 1.11.15

Bereavement after suicide is long-term and you will not be able to ‘fix’ it or make it go away. People need assistance and support, usually for a long period of time, as they come to terms with what has happened.

‘I was in deep shock after his suicide even though I had been bracing for it. He’d attempted it four times, so I guess I thought he wasn’t really ever going to die, that it would be OK.’11

Talking and practical help

Some more thoughts from S (in the story above) about his brother’s death by suicide:

'There is sometimes a kindness in silence, perhaps particularly after a suicide. How much do we really ever know even about those closest to us? We did of course share memories, photos, and mementos; still on his birthday, we talk about our dear departed brother. There is certainly comfort in such sharing.

‘Any life cut short by illness or accident causes distress. But suicide aggravates and intensifies such feelings. However, much comfort can be derived from the sympathy and practical support of friends, relatives, colleagues, neighbours and others, especially when this is given unconditionally, without prying or gossip or curiosity. And those who knew my brother were often ready to speak of his many excellent and lovable qualities.’

See also chapter 8 Talking to Children and chapter 13 How We Can Help.

Notes

1 Harvard Health Publications, Harvard medical school:

www.helpguide.org/articles/suicide-prevention/suicide-prevention- helping-someone-who-is-suicidal.htm

2 See: www.helpguide.org/home-pages/suicide-prevention.htm

3 The Samaritans web site: www.samaritans.org

4 Harvard medical school, Harvard Health Publications:

www.helpguide.org/articles/suicide-prevention/suicide-prevention- helping-someone-who-is-suicidal.htm

5 The Samaritans statistical report: www.samaritans.org/sites/default/files/ kcfinder/branches/branch-96/files/Suicide_statistics_report_2015.pdf

6 Office for National Statistics http://webarchive.nationalarchives.gov. uk/20160105160709/http://www.ons.gov.uk/ons/dcp171778_395145.pdf  7 Mike Parsons, ‘Suicide and the Church’, Grove pastoral series, p123

8 Sarchiapone, Marco, et al., ‘Controlling Access to Suicide Means’, Int J Environ Res Public Health (2011); 8(12): 4550–4562; and

Kreitman, Norman, ‘The coal gas story. United Kingdom suicide rates, 1960-71’, Brit. J. Prev. Soc. Med (1976) 30:86-93.

9 TS comment on Christianity Today website: www.christianitytoday.com/women/2012/august/in-wake-of-suicides- silence-why-blame-is-never-answer.html

10 Support after Suicide: www.supportaftersuicide.org.au/

11 Allan’s story, Suicide support website.

Other resources

NHS choices suicide warning: www.nhs.uk/Conditions/Suicide/Pages/warning-signs.aspx Wertheimer, Alison, A Special Scar: the experience of people bereaved by suicide (Routledge, 1991)