The elephant in the room

Psychiatrists face only a limited number of emergency situations. However, those emergencies can be devastating — to the patient, the family, the care provider, and society. Suicide is the most feared of them all.

Suicide is a hard topic to raise, not just with patients, but also with families, friends, and others. Ignoring it, however, helps lead to the kind of tragedies we’ve seen recently in the suicides of Kate Spade and Antony Bourdain.

While suicides of important social figures rivet our attention, we never hear about the shockingly high number of everyday Americans who take their own lives. The U.S. suicide rate increased by 24 percent between 1999 and 2014, according to a recent report from the Center for Disease Control. During that time, suicides rose from 10.5 to 13 per 100,000 people — the highest rate recorded in 28 years.

In 2016, there were nearly 45,000 known suicides in the nation — more than twice the number of homicides. That makes suicide the 10th leading cause of death. Among people aged 15 to 34, suicide is the second-leading cause of death.

Why did they do it? In working with people struggling with mental illness and suicidal feelings, I have come to realize that there are only a handful of reasons. Hopelessness (or despair) and isolation are, in my experience, the two most common factors. Studies reinforce hopelessness and isolation as major predictors of suicidal feelings.

Isolation occurs when people begin to feel that on one else “gets” them — that no one can help them, because no one else has faced such problems and therefore no one can have a solution.

That belief discourages people from seeking help, which adds to the problem by creating a sense of isolation. Another confounding issue is alcohol and drug abuse, which exacerbates faulty thinking and decision making. Substance abuse also lowers inhibitions, creating an environment in which suicidal thoughts are more easily turned into actions.

For young people, social isolation has become somewhat normalized. The shift to technology-dependent communication deprives them of the benefits of real, human-to-human socializing.

Parallel to the rising rate of suicide is an increase in the rates of depression, anxiety and other mental illnesses. This is not surprising. People today face enormous mental and physical stress: mental in the form of ever-increasing socio-economic pressures, and physical in the onslaught of chemical toxins from food as well as the environment.

For millennia, our bodies have relied on robust nutrition to cope with stress and toxicity. Our modern diets fail to provide that. The Standard American Diet consists of highly processed food that contains refined flour and sugar, while lacking essential nutrients. Our bodies cannot process the chemicals, such as artificial dyes, flavors and preservatives, that permeate such food.

Hopelessness, isolation, stress, along with nutritional and environmental degradation, contribute to a range of problems that can lead to suicide: poor stress moderation, bad coping skills, low distress tolerance, poor problem-solving skills, apathy and despair. Thus, suicide is a complex problem. Finding the cause is like peeling back layers of an onion.

Some economists are characterizing the recent increase in suicide as “deaths of despair” linked to the Great Recession of 2007. More than half of the people who die by suicide do not have a diagnosable mental health condition. They are driven by economic despair.

Suicide is commonly viewed as a “mental health crisis,” but maybe it’s time to view it as a public health crisis.  Unfortunately, we are seeing that the answer to our suicide and mental health problems is not simply making mental health treatment more available. Rates of antidepressant prescriptions have skyrocketed since the 1990s, but suicide rates are climbing.

A recent study co-related increases in suicide attempts and completed suicides in women to a parallel increase in antidepressant usage. It is well known that antidepressants increase suicide risk in young people. It is also now known that long-term use of antidepressants can result in a chronic state of dysphoria (due to tachyphylaxis — a phenomenon in which prolonged use of a substance makes it less effective over time).

Of course, one cannot abandon care delivery systems altogether, but we should all reevaluate what we are doing in response to this pervasive problem.

It is time that we moved away from a simplistic “medication or therapy” solution and worked at evaluating the underlying root causes of suicide — not just at the individual level but at the societal level.

Antidepressants

A recent study co-related increases in suicide attempts and completed suicides in women to a parallel increase in antidepressant usage. It is …

A recent study found that oral contraceptive pills increase the risk of depression and suicide in young women aged 15 to 19 by almost 80 percent. So, is it justified to prescribe an antidepressant to a young woman on birth control? Or, should we dig deeper and evaluate the hormonal imbalance caused by the contraceptive pill and work to fix that?

I would argue for the latter. Addressing suicide requires a comprehensive, multi-modality intervention that addresses issues not just at the individual level but also at the societal level. Within a holistic, root-cause framework, we can evaluate the role of not only hormones, but also nutrition, relationship skills, problem-solving skills, etc., and create real solutions to address those problems.

At the societal level, we can work toward reducing stigma surrounding mental illness and suicide, work on enhancing inter-connectedness with each other, teach meditation and other self-help skills, work for equitable distribution of nutritional and other resources, make our environments less toxic, reconnect with nature, increase awareness and provide resources for vulnerable populations, such as teens and veterans.

But all this can happen only if we talk about the elephant in the room! 

Aruna Tummala is medical director of Trinergy Health, located at 12800 W National Ave, New Berlin, 53151. Click here to learn more.

Citations:

1. J Larsson. Antidepressants and suicide among young women in Sweden 1999-2013. Int Journal of risk & safety in medicine 29 (2017) 101 – 106.
2. Suicide statistics: https://www.nimh.nih.gov/health/statistics/suicide.shtml
3. Oral contraception and suicide: https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2017.17060616