In June, news broke of the suicides of both luxury handbag designer Kate Spade and international food celebrity Anthony Bourdain.  Whenever high-profile celebrities complete suicide, we are reminded that depression and mental health conditions touch every class of people and inevitably look for explanations of why anyone, even wealthy, successful people, would take their own lives.  The truth is that suicide rates have been increasing dramatically over the past two decades.  The trends are startling.  Suicide rates have increased among every single age group from 10 to 74 since 1999.  Rates are up 25% overall across the country.  Approximately 300-400 physicians complete suicide every single year.  In fact, physicians are more at risk for suicide than the general population of both males and females.  Over 20 Veterans complete suicide every single day.  Keep digging, and the facts don’t get any better.  2/3rds of firearms related deaths in this country are due to suicide.  Over half of people who complete suicide had no known mental health problems.  1 million Americans lose their doctor to suicide each year.

Why are we seeing this dramatic increase in suicide rates?  The problems are deep and resonating throughout our culture.  Isolation and hopelessness are leading emotional triggers for suicidal ideation and attempts.  We tend to blame suicidal ideation and behaviors on mental health problems, but the conditions that contribute to suicidal ideation go far beyond what is going on in people’s minds.  Emotional circumstances such as grief and loss are certainly a factor, but so are economic circumstances (homelessness and dire financial pressures), relationship circumstances (isolation and rejection both romantically and socially), and employment circumstances (overwhelming stress, abusive management, lack of basic respect, micro-aggressions and discrimination or harassment in the workplace).  Once again, when it comes to suicide, we want to simplistically blame mental health problems and offer medications or treatment to individuals without ever addressing the root causes of the distress in the first place.  To be clear, of course people who have suicidal ideations need treatment and professional care.  However, as with all problems if you continue to live with the circumstances that are the cause of your distress, the relief you experience from individualized treatment is limited.  The alarming statistics with regards to suicide rates are indicative of our broader cultural problems, and we likely will not see remittance in these rates until we truly de-stigmatize mental health treatment, provide increased access without fear of retribution or loss of reputation (a primary concern for impaired professionals), and start to shift our culture of individualistic solutions to systemic cultural problems.

I have worked with countless individuals who are either actively suicidal or have been in the past.  In my clinical observations, most people who verbalize suicidal ideation do not really want to die.  They want their lives to get better and they feel so hopeless that their circumstances will change that they come to the conclusion they would rather die than to continue to live their lives under the current conditions.  This is not to say that there aren’t people who do truly want to die.  Getting at the truth of whether someone really wants to die is a critical component of suicide intervention.  When you can help someone recognize that there is hope for their life to get better, they may become more receptive to getting the help they need to prevent suicidal behaviors.  When someone really and truly desires to die, they may actually avoid seeking help altogether because they do not want the intervention that comes from admitting that truth.

We often call people selfish who complete suicide because of the pain it causes to their friends and family left behind.  For some though, the decision to complete suicide comes after a period of intense contemplation, during which time perhaps the only thing keeping them alive is the desire NOT to hurt their loved ones or cause them more pain.  In reality, some people who complete suicide believe that they are a burden to their loved ones.  They may not want to place a further burden on their friends and family by asking for help.  This is why it is often so hard for people who really want help to come forward, and why we sometimes hear that someone has completed suicide with almost no signs of distress to their friends and family, as was the case with Bourdain from initial reports.

Perhaps in light of the alarming trends we are seeing there will be some increased funding and decreased stigma towards mental health treatment.  That would be an excellent start.  The military is a useful example of how these issues play out in reality though, and I am speaking as someone with a background in clinical counseling with military service members and their families..  Certainly, in the military there has been increased attention to suicide prevention and response, yet actually dedicating the appropriate resources remains a problem.  There may be flyers posted everywhere and mandatory in-services and dozens of pages of written protocols and programs. When it comes to changing the culture of All-Results-All-The-Time-No-Excuses that causes soldiers and sailors to lose hope though, there is no light at the end of the tunnel so to speak.  It’s akin to treating the symptoms of a disease but never addressing the root cause.

We can continue to press for more treatment resources, and more public awareness so that we can foster a compassionate culture that responds to the needs of those contemplating suicide.  However, we must do more than that to foster a culture that allows vulnerability to exist and does not punish people who seek help.  We must seek to change the circumstances that are causing undue distress.  It is not reasonable to expect the intense and rigorous standards required by medical schools to result in people feeling so overwhelmed that they choose to die.  It is not reasonable to expect our military service men and women to behave as though they are robots with no feelings or needs of their own just because they signed a contract to serve their country.  When the needs of individuals cease to have any value to the systems that they work for, we cannot then blame the individuals for turning out to be human, with human limitations and human needs.  Neither can we expect people who are suffering from severe clinical depression to be able to battle the stigma of seeking help by themselves.  We all owe it to each other to listen with compassion when we know someone who is struggling, and advocate in any ways we can towards changing the outcomes of this growing problem.  More than just connecting someone to professional help, which should be done as soon as possible, we need to listen to people in order to discover the root causes of their hopelessness and fix these broader problems as well if we want to truly make a dent in this tragic epidemic.

For more information and resources on suicide, visit the National Institute of Mental Health here:

www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml

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