To Live or Die the Nature of Suicide

By Joan E. Childs, LCSW

Why do people choose suicide? Is it always a conscious choice? The answer is not simple. When we know that self preservation is the strongest human need, how can we understand and explain the answer to this very complex question?

The recent suicides of Anthony Bourdain, Kate Spade and Robin Williams– the over-dose of drugs that killed Philip Seymour 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. The organ we know least about is the brain. The brain is the only organ that cannot self regulate. Neuro-biologists tell us need another brain to calm down our central nervous system. We are at the foothills of learning and discovering what a complex organ our brain is.

We now know that Bipolar Disorder is an affective disorder, now on a spectrum from the most difficult to manage, Bipolar I, to Bipolar II, easier to manage with medication. There is soon to be a spectrum adding a Bipolar III and IV. Many with Bipolar II 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.

It is my belief that 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, I believe 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. Add anger and rage to the equation and you can expect a homicide as well.

The issue of suicide is a global concern. In the US alone, more than 45,000 people commit suicide each year with the numbers rising exponentially every year. There are more suicides than homicides. Mental illness is the culprit, with depression the leading cause. Depression is widespread and so are the implications and consequences. Some choose suicide; others, homicide. This brings in the complex issue of gun control.

We have all heard of mass murderers who were described as “the nicest guy on the block; wouldn’t hurt a fly, quiet and unassuming, etc., and yet, without warning, they find their way into a church, school, theatre, and/or concert with an AR-15 rifle and annihilate innocent victims. Mental illness pulls the trigger. So without attacking the second amendment, we need to make some changes to accommodate the millions of people who are suffering from depression and murderous rage. There has to be a way to control who gets the weapons. Sometimes the signs are there but go unnoticed or denied. Too often, these folks slip through the cracks and manage to wreak havoc on society.

Last month two of my grandchildren who attend MSD High School were subject to the killing of 17 of their classmates and teachers. An AR-15 rifle was used to slaughter the victims. There is no reparation for this tragedy. Students, families, teachers and the citizens of Parkland will maintain emotional scars forever.

I don’t have the answer. Obviously there has to be a cooperative effort with the demands of gun control and the NRA, otherwise we are looking at a society that has gone crazy and has become the “killing fields”. There also must be treatment provided for the mentally ill as well as gun control. It is a joint effort: mental health facilities and gun control otherwise, we are looking into a future of violence.

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.

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