To Be or Not to Be? To Live or Die? The Nature of Suicide

Why do people choose suicide and is it always a conscious choice?  The answer is not simple.   It is both yes and no.  When we know that self preservation is the strongest human need, how then can we understand and explain the answer to this very complex question?

The recent suspected suicide of Robin Williams, the over-dose of drugs that killed Seymour Philip Hoffman and Whitney Houston and so many others unknown, brings to our minds just how delicate the balance is between life and death.  Without a note, it is impossible to know if the suicide was pre-meditated or that an impulse carried out the order.

In my book, WHY DID SHE JUMP? My Daughter’s Battle with Bipolar Disorder I wrote convincingly that it was not she, my daughter who took her life; it was her illness, Bipolar Disorder 1 that was her executioner.  Having struggled with this insidious brain/chemical disorder for more than ten years from age 24-34, that included paranoia and audio/ visual hallucinations, it was my conviction that it was her treacherous disorder that threw her out the window.  What caused that moment?  I will never know, but having experienced her with all her delusions, I feel certain that her death was not by her own will.

When a person has a belief system that is unshakable as did my daughter, it is very difficult to reason with that person.  In her disturbed mind, she believed unequivocally that the devil was going to take her soul.  With all the years of psychological treatment, her belief system stayed unchanged.  This is true of the suicide bombers who have been conditioned to believe that by being a martyr and killing an infidel, their next life becomes their true life.  Once a person is committed to their belief system, whether through a mental disorder or brain washing, the progression is to create a value, then an intention, then a state and finally a behavior: suicide.  It takes a hell of a state to pull the plug on one’s life!

In her book, HIS BRIGHT LIGHT, Danielle Steel describes her son’s outrageous behavior with exact detail of how I witnessed by daughter’s slow descent into hell.   He too leaped to his death as did she.  Bipolar Disorder 1 has a very high correlation with suicide and most of them are violent.  Rarely have I heard of someone just taking an over-dose of sleeping medication or tranquilizers.

Psycho-tropic medications are still hit and miss.  Everyone’s brain responds differently to these drugs, so what might work for one patient might have devastating effects for another.  Even if there is a positive response, many patients with Bipolar Disorder are non-compliant and self regulate or abstain completely from their medication.  For many, they don’t want to give up the highs when they are hypo-manic, as they believe that the medication interferes with their creativity and performance.  For others the drugs can cause lethargy and an inability to function.  Because Bipolar mimics so many other mental illnesses,  co-morbidity as it is known, makes it very difficult to obtain a differential diagnosis.  There are no MRI’s, blood tests or lab studies that can determine the exact diagnosis as in physical ailments where lab tests, x-rays and scans can deliver an accurate diagnosis.  Psychiatrists and mental health counselors must rely on their interviews, medical management and chemical responses before a differential diagnosis can be made.  It can take up to ten years to determine the exact diagnosis for Bipolar Disorder. The organ we know least about is the brain.  We are at the foothills of learning and discovering what a complex organ our brain is.

Bipolar Disorder

We now know that Bipolar Disorder is an affective disorder, now on a spectrum from the most difficult to manage, Bipolar I, to Bipolar 11, easier to manage with medication.  Many with Bipolar 11 can live a very successful and high functioning life with medication.  More than a million people view web sites that can give answers and more than six million people in the US suffer from this disorder.  In addition we have to look at acute depression that renders a person hopeless to their suffering, too often seeing suicide as their only relief from chronic pain, both physically and mentally.  Most don’t want to leave a legacy of suicide to their loved ones, but see no other options available.  This too can be managed with effective treatment, not easily available in our health system.

Not unlike Robin Williams, many have a dual diagnosis.  They are addicted to a substance like alcohol and/or drugs and use it primarily to self medicate and manage their feelings, only complicating matters more for treatment and for their own well-being.  Alcohol we know to be a depressant, so when a patient attempts to self medicate with alcohol, they are only exacerbating the issue.  The first step is to modify the behavior and go into recovery; essentially become abstinent from all substances that are being used to manage their feelings.  Not until then, can a person be diagnosed and treated effectively.

Most of our homeless are not lazy or uneducated.  They are sick and need mental health services that are almost impossible to receive.  My own daughter, a brilliant, beautiful, vibrant woman with a PhD, could not receive the help she so desperately needed.  If she didn’t have a family to care for her, she too would have been homeless and on the streets.   I blame our sub-standard health system for her falling through the cracks.  Since her death in 1998, our health system still falls short of caring for our mentally ill.  The mass murderers, kidnappers, pedophiles, rapists are all sick with some form of mental illness, that if treated or placed in long term mental facilities could keep our citizens and children safer than what we have witnessed over the last few years.

In adolescence, one of the highest suicide rates, permanent solutions are made to solve temporary problems.  Their emotions are stronger than their cognition.  When they feel isolated, lonely, desperate, broken-hearted, bullied, abused, neglected or abandoned, they don’t see another choice but to kill themselves.  With a little love and attention, this can be easily resolved.

The stigma and shame that clouds our needs to be more open and honest with mental illness must be lifted.  We have seen enough.  We have witnessed the worst atrocities right here in America.  It’s time we came out of the dark and into the light of awareness and truth.

Joan E Childs, LCSW is a renowned psychotherapist, inspirational speaker and author of Do You Hate the One You Love: Strategies For Healing and Saving Your Relationship. In private practice since 1978, she specializes in individual and couple’s therapy, grief therapy, EMDR, NLP, inner child work and codependency. Learn more about her services at www.joanechilds.com.