In the past few months, suicide has been on my mind. It’s there in the exam room, as I hold space for the overwhelming grief of a parent who has lost a child. It’s there as I talk with other mothers about the steep and shocking rise of suicidal thoughts, suicide attempts and suicides in young people triggered by the fraught milieu that is social media. It’s there as I work with people navigating overwhelming stressors, loneliness, isolation, depression and hopelessness. It’s there as I reflect on those who have made this most painful decision, and on the grief, confusion and guilt left in its wake. And it’s there as I contemplate the challenges of my own profession, which lead so many to look for a way out.
We are in the midst of a public health crisis. A report published in 2018 by the Centers for Disease Control found that between 1999 and 2016 (the most recent data we have), suicide rates nationwide increased by 31 percent. Suicide is the second leading cause of death in people aged 10 to 34, and the fourth leading cause of death of those aged 35 to 54. One in five people consider taking their lives at some point in their life, and a majority of these people do not have a diagnosed mental health condition. Women attempt suicide more often than men, but men more often die. White men and Native American men are at highest risk. Of personal poignance to me, physicians die by suicide at twice the national rate, and female physicians at a rate 250 percent higher than our non-physician female counterparts.
We need to talk about it. The stigma around suicide causes people to suffer in silence, which increases the risk that they will act on suicidal thoughts. People are often concerned that talking about suicide increases the risk of self-harm, but that is not the case. In fact, speaking openly about suicide gives those who are in anguish the opportunity to share what they are feeling. Telling a compassionate, nonjudgmental individual about one’s suffering decreases the chance that one will act upon it.
When we understand the non-rational thought loops a suicidal person becomes caught in—and the emotional and life experiences that put him or her at particular risk—we can better respond in effective ways. Human beings are social creatures by nature. When we feel isolated, when we feel we are a burden to others, when we are thwarted in making social connections, we feel extreme stress. Feeling hopeless about our ability to change these factors creates intense psychological suffering. If a suffering individual is also navigating major life stressors, or is drinking alcohol or using drugs (especially opioids), the risk of suicidal thinking rises. Some people—due to childhood trauma, genes, a lack of positive role models in navigating stress, or deficient self-care practices—have an even harder time coping with intense stress and are more likely to consider or attempt suicide.
Given these risk factors, we can understand how imperiled our young people are now. Recall the stress of adolescence, and the developmentally-appropriate importance placed on connecting with peers as we individuate from our parents. Now imagine trying to make meaningful and healthy connections on a social-media platform. These venues are a recipe for thwarted connections and invite the constant comparison of oneself to others’ projected “perfect” selves. Rates of anxiety, self-harm and suicide rates are escalating in large part due to this toxic exposure. Parents: think carefully about whether you want this to be part of your child’s experience. Flip phones may turn out to be an important element in suicide prevention for young people.
How can we respond thoughtfully and proactively to the suicide crisis? How can friends, family, community members, medical and mental health practitioners be attuned to the needs of those who are suffering, and respond in a helpful way?
Listening is essential. Suicide hotlines like the National Suicide Prevention Lifeline (800.273.TALK) are staffed by trained listeners. When someone is thinking about suicide, it is essential that they connect with a mental-health professional. Engaging in therapy has been found to significantly reduce the likelihood of committing suicide and supports people in cultivating life-saving skills that promote resilience in the face of major stress. If someone is actively suicidal, call 911.
It is also essential to create conditions of safety around a person who has been contemplating suicide. Often, the decision to act on what had been a thought happens quickly. One study found that for more than half the people hospitalized for a suicide attempt, the time between their decision to act and their attempt was less than 10 minutes. This speaks to the importance of minimizing access to lethal means, such as firearms or dangerous medications, for those who have considered suicide.
It also speaks to the importance of knowing the signs that someone may be suicidal, and of reaching out to them. These signs include talking about wanting to die, hopelessness, social withdrawal, giving away belongings, saying goodbye to people as though they won’t be seen again, agitation, intense anxiety or mood swings coupled with the above symptoms, and increased use of drugs and alcohol. Substance use can be a sign of the desire to soothe or numb emotional pain; it also puts someone at a greater risk of acting impulsively. Though doing so can be difficult when an individual is withdrawn, creating a network of connection around a suffering individual is one of the most powerful ways we can create safety for others.
So many of us have been touched by suicide. It is a tragedy that we must hold in the collective, and find a communal response to. Many in our community are grieving recent losses, and we can create spaces to gather to hold our grief. We can also create a culture that permits us to break the silence and skillfully and compassionately listen in the face of suffering.
Next month we will have an opportunity to come together to discuss this. On Thursday, July 11 Elizabeth O’Brien, the Coastal Health Alliance’s behavioral health specialist, and I will co-facilitate a community dialogue, grief ritual and skill building session at the Stinson Beach Community Center. We will meet from 6:15 to 8:15 p.m. Please come. Then, on Aug. 14, I will facilitate a community medicine circle in the Commonweal Garden on mental wellbeing. Please RSVP to firstname.lastname@example.org if you plan to attend either gathering so we have a chair for you.
Dr. Anna O’Malley is an integrative family and community medicine physician at the Coastal Health Alliance and the director of Natura Institute for Ecology and Medicine in the Commonweal Garden. Her favorite self-care strategies are communing with nature and dancing.