How to detect the possibility of suicide in someone close to you

Be aware of the cofactors of high risk suicide.

Readership: All
Length: 1,000 words
Reading Time: 4 minutes

In this post/video, I’ll talk a little bit about suicide and how to identify the potentiality of it happening.

What to look for in your loved ones if you are worried about suicide. (Length: 7:30)

First, I’ll cover this in a general sense, and then I’ll go into some specifics about how it relates to men and men’s issues.

The General Confusion Surrounding the Probability of Suicide

Suicide, and acknowledging that you want to kill yourself, is not a particularly pleasant topic to talk about.

It is also something that has not been very well studied and documented. So the literature and our knowledge about it is slowly grinding on to a better understanding.

It is something that we in the mental health profession are still a long way from being able to diagnose with any degree of certainty. We have not been able to condense the ingredients of a suicide, to the point where we could give the patient/client a questionnaire, and know beyond the shadow of a doubt that this person is about to kill themselves. We are very far away from that point.

Whenever a low base rate phenomenon occurs, like suicides, mass shootings, etc., somebody always puts a microphone in front of me and says, Dr. Klajic, why couldn’t we have predicted this?

Mostly, it’s because it is a low base rate event. This means that we don’t have enough data about it to study and to be able to generalize it out to the larger population. We just don’t have enough statistical power. Anything that doesn’t happen very often is difficult to study.

Even after we add in all the cofactors for suicide (as discussed below, gender, intoxication, and so on), then we start to see that the probability that someone who is imminently suicidal is going to walk into my office, and I’m going to detect it, is very very low.  

Even though we mental health providers like to think that we can predict these kinds of things, in fact, we’re not very good at that. It’s just not that likely.

So that’s the bad news.

What do we know about Suicide?

Here’s a couple things that we do know about suicide.

There are a number of factors that go into either a suicide, an imminent suicide, a suicidal mindset, or what some people call suicidology. We don’t have a great name for it.

We call these factors, static and dynamic factors.

Static factors are things that you can’t change and are not going to change. For example…

  • Present age
  • Previous attempts at suicide
  • Sex
  • Personal characteristics

Dynamic factors are those situations that the person is going through in their life right now. For example…

  • Divorce
  • Getting fired
  • Bankruptcy
  • Alcoholism

All these things are dynamic in the sense that it changes from day to day.

Aside from all that, what we also know from the literature are some cofactors that go along with a situation in which people try to kill themselves.

I won’t quote any specific citations that would be useful for this, but basically, what we know is that…

  • A humongous percentage of suicides have happened within 90 days of an emotional disruption or a significant life event. For example, a devastating break up or a divorce has happened very recently.
  • Of that group, most are men.
  • Of that group, a vast majority of those people have not seen any health professional within the past 12 months leading up to their suicide – not a podiatrist, not a dentist, not anything.
  • Of that very large group of folks, most of those will make the decision to kill themselves within 24 hours after they get the thought.
  • A pretty significant percentage of them will do it within 8 hours.
  • A pretty significant percentage of them will actually do it impulsively.

So that’s the average profile.

What can we do about this?

Whenever a competent health professional is evaluating a patient, he is supposed to be assessing a person for suicide risk. They should always have these risk factors going through their minds in the background, like an algorithm or a script, whenever they are evaluating someone, even if they are just in a therapy session.

It’s not that everyone is suicidal, but everyone has some pretty rough spots in life. Everybody goes through break ups, job losses, and these other kinds of experiences. Everybody has these kinds of thoughts in their lives.

Those kinds of disruptions are particularly difficult for men in the ambient culture that we live in.

Since men tend to kill themselves at a higher rate, using more lethal means, I think it’s important that we start looking at why that is, instead of just looking at it as a static risk factor.

The good news is that most of these factors can be detected much more readily by the people around us.

We should be empowering people to be looking at the people closest to them, and being able to recognize that. We should be able to say, “Hey!  This person just lost their job and broke up with their wife/girlfriend, and they haven’t been to a doctor for a while!  They are at a higher risk for suicide!”

The hard part of identifying a person with a high risk of suicide is that suicide is supposed to be a secret until you do it, or else, someone will try to stop you.

That’s the catch 22. If I’m really wanting to kill myself, then why would I tell you about it?  Because then you’ll only try to stop me.

The deck is stacked against detecting those who are truly suicidal, but that doesn’t mean that we can’t be more aware of the risks and factors, and make some effort to recognize those risks in people who are close to us.

406-594-1168

I also do coaching across state lines.

Related

This entry was posted in Collective Strength, Discernment, Wisdom, Disorders, Divorce, Fundamental Frame, Health, Love, Psychology, Relationships. Bookmark the permalink.

44 Responses to How to detect the possibility of suicide in someone close to you

  1. cameron232 says:

    My grandfather did the Dutch Act with a pistol. A few months after he retired (was an MD). He had a dark personality. He was a tall, very handsome man in his youth (Hollywood looks) who had lots of women including when he was married. Had the huge house, nice cars, a much younger wife, respect of the community he served, etc. Didn’t matter.

    When I seriously wanted to shoot myself it was over lack of having a girl (as a teenager) or the one time my wife and I had serious marriage problems. I have had brief fleeting thoughts of suicide for a long time but I think that’s not uncommon. For awhile I would only own a .22 because I figured I wouldn’t risk turning myself into a vegetable in a sudden fit of despair. Sometimes “the world sucks and is going to destroy my babies” is my despair.

    I have stashed away a rifle for each of my sons as an insurance policy against a society that hates them because they’re white, conservative, straight males. I’m still afraid it’s more likey statistically to end their lives than to save their lives so they don’t know about it – I don’t give it to them as they leave the nest.

    Like

    • Scott says:

      The biggest risk in your situation is the genetic component. (People who commit suicide or at least attempt, actual, lethal means regardless of success) tend to have immediate family members who did. In your case, grandfather, is not “immediate” but the temperament is there.

      The three factor model that is the most promising (besides simple risk and protective factor analysis) is Joiners. It contains:

      Thwarted belongingness
      Perceived burdensomness
      Acquired ability to commit suicide.

      They are pretty face valid in their descriptives (they pretty much are what they sound like). A person who who was once a part of something, and now is not, plus feeling like they are better off dead (to their loved ones) and has practiced, thought through, planned the act.

      That person is a high risk individual.

      It explains why men, (in particular white, “heteronormative” men) are killing themselves in droves. Its almost like there is a mass-level attempt to cause those (first two) factors in one particular group of undesirables so they just kill themselves. We get a big dose of the first two, every day, all day from the culture. Think about it:

      You don’t belong. You have no culture. You have nothing to be proud of. You cannot participate in the process. You are not welcome to be apart of this civilization that your ancestors built.

      Your family and everyone around you would be better off if you did not exist. They need your money/earnings, but not you. Not your influence as a father, you, as a person are a net loss for them because your presence is “toxic.”

      (That’s societal level thwarted belongingness and perceived burdensomness in a nutshell)

      We are being brainwahsed into killing ourselves.

      Liked by 3 people

      • Liz says:

        Once you identify someone is a high suicide risk, how do you talk to them?
        I always worry about making things worse.
        And it’s very difficult to make them get help. In the military they can make someone go to counseling, not so in the civilian world. Also the China-pox makes it prohibitive (most therapy these days is virtual, which has an impersonal element).

        Liked by 1 person

      • cameron232 says:

        When a man with children kills himself he makes his kids life worse. My dad didn’t have agood relationship with his father but it still took a toll on him.

        Like

  2. Scott says:

    Liz-

    As far as talking to them, there is no evidence to suggest that bringing up the topic of suicide will increase the risk. Its one of the novice errors mental health professionals make in training/internship. They fear that bringing it up will somehow put the idea into the persons head.

    But this is the conundrum in a nutshell.

    The idea is in their head already, and there is probably just about nothing you can say to a person who has the intent to die to change their mind. This might all be in the video (I haven’t ever actually watched it since I made it) but here is what we know:

    The mode suicide is a male who is under 24 or over 44.
    He has recently (within about 90 days) been hit with a disruption in a siginficant other relationship (he is going through a divorce, break up)
    He has not been to see a provide of any kind (not a PCM, nothing) in the last year
    He made the decision to kill himself in the last 24 hours.
    He has the means
    Has a genetic load for suicide or has a nasty mental health disorder (diagnosed or not)

    I would add:

    He meets all three criteria from Joiners model, and is not going to tell you about it, because the point of suicide is that you keep is a secret until you are done.

    All this means that the probability of an imminently suicidal person (someone who is about to be dead) is going to talk to you , or anybody else about it basically zero.

    So talk away. It is not likely to help, but it certainly can’t hurt. My guess is you have to combat the demons that are represented in the model if you have any hope of changing the outcome. Let them know-you belong to something. (Factor one) Your wife left? You are still valued by others in your peer group. You matter. We need you here. Let them know the world would be a worse place without them. (Factor two). Your presence in the lives of these people… (be as concrete as you can) is needed, appreciated, wanted.

    And give them future orientation. (A protective factor model)

    Today your life is shit. It is a temporary problem but it will end. But you must stay alive to see where it goes. You may not be able to articulate what the solution looks like, but it exists and the only way to find it is to live.

    Liked by 3 people

    • Lexet Blog says:

      I happen to know a lot of people who have committed suicide. It goes with graduate degrees.

      The common factors I saw were drugs, alcohol, and high drama life style. I’m pretty certain childhood abuse was present in all of them.

      The ones who upped and immediately offed themselves with no warning were female.

      All the men had pasts of discussing it. It’s common to see people do it when they fail exams such as the bar (or med school equivalent). That’s because at that moment your career will essentially be permanently impacted in a negative way, and there’s no undoing it.

      However, out of all the people I know who did it, only one was understandable. Funniest mother f’er I’ve known. History of family abuse. Severe ptsd from the war (spec ops). Family destroyed from deployments. One close relative did it shortly after. Got into painkillers after, and the VA essentially enabled his habits after.

      His life was on the upswing, but it was also at the point where a lot of his squad and platoon mates had killed them selves (abnormally high numbers).

      One day he took a few too many pills with alcohol, and his mind snapped. Was put into a 72 hour hold. Mandatory treatment. A month later he was gone.

      Depression and coping with alcohol and narcotics was inevitable. But I blame the shit the va put him on by force.

      If you can converse with a person, it’s not too late. Those who are dead set in their plan will cut off contact and push you away.

      Like

  3. Scott says:

    To expand a little further.

    Suicide has been posited and conceptualized by some as problem solving behavior. And looking at in such a way, one sees quite quickly that an empowerment model must be deployed which is counterintuitive when killing yourself is one of the options.

    David Jobes uses this approach (he is a collaborator with Joiner) in his Collaborative Assessment and Management of Suicide (CAMS) system. In this framework you empower the individual by allowing them the dignity of having suicide as an option.

    If you are “lucky” enough to get a client who is coming right and telling you that they are thinking this way, you must have the rock hard stomach to say:

    Yes, this is a problem. Here are your options

    Kill yourself
    Read a book
    Listen to music
    Go over to a friends house
    Go workout
    etc…

    Now, let us use the process of elimination to see which of these are the most rational.

    Of course, you are trying to eliminate suicide from that list of options, but if you just threaten to put them in the hospital you are taking psychological power away from them, and they are already feeling like that.

    Now, I am not a particularly good therapist, as my bedside manner is generally regarded as obnoxious by most people. Its why I stay in my lane–which is assessment, forensics, etc. I would rather just say “suicide is fucking stupid because you are quitting. What are you going to do, let the world win?”

    That approach probably only works for a small group of people, mostly men. Mostly the kind of men who hang around this part of the internet. Which is like 5 people.

    Liked by 2 people

    • Lexet Blog says:

      That probably works a lot better with veterans than anyone else.

      among the vets I know who killed themselves, they- to a man- thought safety stand-downs and safety briefs were gay

      Like

      • SFC Ton says:

        LOL that’s because they are gay

        All most all the door kicker I know who checked out did it over wives who went whoring.

        Or rather that was the last step.

        I do know one man who wired his automatic opening device shut and burned in from 25k feet. He had terminal cancer and dying on duty paid better back in the day. A friend of mine with no legs also killed himself. Never could tell 8f it was loosing his legs and junk or the pain pill addition.

        Past that, everyone one of my guys who killed himself did it over a bitch. And most of those guys didn’t have clearances to worry about and were never planning on staying in for 20 years so they didn’t have those things to protect.

        I did a thing with a head doc in Canada about all of this. It was floating around the man o sphere years back so forgive me if this is old news. I think the chain starts before men enlisted, with most young men not being particularly mentally healthy/ emotionally robust.. Almost no one is, given how dysfunctional our culture and society has become. Then our media etc etc tells him the war is bullshit…. then the man realizes all he did and went through for america was utter bullshit/ had nothing to do with defending a damn thing he values. Throw in the wars have been big picture failures, and the small wins not worth the price you and your brothers paid…… The bullshit keeps piling on…… his value system is destroyed by the real world and the mountains of 0 fucks folks have for his world view. the last straw is a bad marriage/ unfaithful wife/ baby momma fucking some other dude.

        The military gives 0 fucks. Society gives 0 fucks. The shot callers never say the military option isn’t the best one or the objectives are not feasible or not worth the price. They keep shoving bodies into the grinder instead of speaking up risking their retirement check.

        Wife leaves you while down range? Army regs help her fuck you over, often she gets the help of your leadership’s wives. She cheats on your while your at the two way rifle range? She still gets your kids and cash. No justice done. No help in preventing her from moving your kids out of state. No compassionate reassignment so you can see your kids on the weekend, its judges who tell you to fuck off ( in polite legal speak but not always) money gets tight becuase child support and legal bills….. his loosing streak keeps getting bigger and longer, each magnifying the other and all his problems stem from him trying to do what’s right. God and country, family and duty…. his value system ends up being the source of all his problems

        Stand down days won’t effective the root causes or break that chain

        I know Scott does what he can, no disrespect intended, but the problem is infintly larger then that

        Like

      • Lexet Blog says:

        The majority of army aviation crashes are directly tied to domestic incidents. I know some pilots who had wives that would intentionally harass them before flights.

        One of them crashed and all on board died. Phone logs showed the wife called pre flight. They had a marital dispute at the time.

        Like

      • Lexet Blog says:

        To note to any who think the military treats their people well. When my dad divorced, he was forced to live off post, even though he had full custody over me. She got to live on base. Think about how shitty you have to be to lose custody of a child in a military community way back in the day.

        Officers above the rank of captain are often pieces of shit.

        Like

      • Lexet Blog says:

        To your point, all the people I know who served and did themselves in came from broken/abusive homes

        Like

      • SFC Ton says:

        I believe that to be true with the soldiers I lost. I sent rightly recall for the last one. It was some years between when we served and when he pulled the trigger.

        One of my guys was fighting with his wh0re over Skype about her infidelity and at one point just said “f_ck you b_tch” and killed himself with his m9 in front of her. His home life was a f-ing train wreck and that b-tch wanted her new d_ck stand to attend his funeral.

        And yeah wives say fucked up sh-t to dudes down range all the time, them saying something like “I hope you die over there” is way more common then it should be, and I know one guy whose last words he heard from his wife was “f-ck you”. Who the f says something like this when your spouse is down range?

        One of my things is, it should be illegal for service members to marry. 50’ish % of the wives in an infantry platoon will get caught wh0ring around within a 12 month deployment. And that’s just the ones who got caught. Then like I said the army by default punishes the grunt.

        I won’t get into my opinion regarding officers and career guys in general.

        Like

  4. Scott says:

    Also, to be precise, there is no mechanism in the military to order someone into treatment. You can order a soldier to be evaluated for a specific referral question when harm to self, others or the nebulous “mission” is threatened. But once the assessment is complete, the servicemember can refuse treatment.

    The closest thing that exists is in the legal world, when a defendant is determined to be unfit to proceed or incompetent to stand trial (this language is jurisdiction driven). Then the court can order the person to be restored to competence or fitness so they can face justice. This is usually done in state hospitals and constitutes forced treatment.

    Liked by 1 person

    • feeriker says:

      I think we would agree that those serving in the military will go to extraordinary lengths to hide a problem like suicidal thoughts or ambitions, especially if they work in a field that requires a high-level security clearance.

      There is a lingering perception among such people, which was at one time a reality, that any diagnosis of mental health issues mean a permanent revocation of one’s security clearance and thus the destruction of one’s military career. Although this is no longer officially policy, the social environment within such professional communities is sufficiently low trust that few people believe that an attempted suicide will result in anything other than the end of one’s career. Even if attempted suicide is insufficient legal or medical grounds for revocation of a security clearance, “the system” will invent some other pretext for revocation and for getting rid of them. Needless to say, this lingering fear of the system only exacerbates the existing condition and makes suicide attempts even more likely among individuals so disposed.

      Liked by 3 people

      • Scott says:

        A couple of things have to teased out here, for anyone associated with the military and reading along.

        Your comment touches on a couple of related topics that interact with each other:

        The stigma of military mental health (in general)
        Going to mental health and security clearance

        It is important to recognize that the military has been trying as hard as it can to cut a huge hurricane width trench in the general stigma of going to mental health, for the entire time I have been a provider. In fact, I would argue that they probably should dial that back a little, because the leadership now looks like they are virtue signalling when they make army PSA videos about how “I’m the Sergeant Major of the Army and I was having problems in my marriage so I went to a counselor and every thing is fine now.” Everyone rolls their eyes at that. As if the CSA is going to have ANY blowback from a visit to a marriage counselor.

        Next, on whether or not a trip to mental health will effect your TS or S clearance, its complicated.

        The intersection of HIPAA, harm to the mission, risk to self/others is a complex set of variables that must be assessed on an individual basis (and it is) by the psychologist who is looking at each case. It starts with the context under which you were seen.

        Had a little “deployment irritability” when you back, and your marriage was a little off? No shit. I was a mental health provider with a TSSCI clearance and I had that. Didn’t lose my clearance.

        Were you ordered to go to mental health (I wrote about this in an upthread comment)? Well, not so fast there partner. The regulations guiding those provide almost zero confidentiality for the servicemember because the order was given under the “potential harm to mission” exception to HIPAA rules about mental health in the interest of national security. If you had a CDBHE (Command Directed Behavioral Health Evaluation) and you were determined to be in need of a medical discharge or MEB, then why was that? How acute/intense was the disorder or suicidality? How long ago was it? What kinds of secrets to you access to? Are you a heavy drinker? Been arrested? Could the enemy use your situation to exploit that? What is the risk/reward calculation of allowing you to keep the clearance?

        Do you see how quickly this gets complicated? Yes, people DO lose their clearances under that crazy system. And usually, they should.

        Financial problems? Risk is high because selling secrets could help you get out of debt

        Infidelity uncovered in the evaluation? How about an agent blackmailing you?

        This stuff does matter. I would advise anyone with a clearance about all of this before deciding to go see someone. But if you are being ordered to, chances are pretty good there is an issue that increases risk to the government. Can’t help that.

        Like

      • Lexet Blog says:

        I hear the stigma over clearances a lot, but the real fear is getting kicked out combat-arms branches.

        People don’t talk to family because they can always get a restraining order or bring it up in divorce.

        The first move an attorney will make when representing the wife in a divorce is to bring up any counseling issues and gun ownership. This sets their client up for a TRO and gains sympathy with the court. That TRO Will end your career if the court finds a basis for it and orders a permanent order.

        Like

      • Scott says:

        Correction, SMA

        Like

    • Lexet Blog says:

      Quite frankly, the only way to force into treatment is off post in Baker-Act states that allow for a 72 hour hold.
      However, the result of such actions would lead to more suicides, as such actions will lead to the end of your military career.

      The military will never end high suicide rates until they either stop deploying or develop a system of retention that allows you to still advance in your career after demerits/pauses for treatment. As it’s cheaper to just discharge you with benefits and recruit enlistees, that will never happen.

      Like

  5. Joe2 says:

    Scott,
    Several years ago, I used to eat at a local restaurant and was usually served by the same 20+ something waitress – very attractive, very pleasant, excellent social skills. She always found time to talk about her day which I enjoyed.

    I heard from customers that one night there was some excitement at the restaurant – the police, fire department, and para medics showed up. Naturally, the next time I saw her I asked what happened. She said that it was nothing. They just found an employee passed out in the back room due to an adverse reaction to some prescription medications. The hospital was able to revive her and she is O.K. Then in a rather low voice she said that is the official explanation, but that’s not what happened. She said the employee caused the adverse reaction because she tried to commit suicide that night. No one at the restaurant or the hospital knows the real reason. I said is that what she old you? She said you’re speaking with her.

    Honestly, I was shocked and at a loss for words. I mentioned that she should now tell the hospital, but she didn’t seem too interested. She had already quit the job by the next time I was at the restaurant. Why would she tell me the real reason?

    Liked by 2 people

    • Jack says:

      Joe2,
      I’ll give a speculative guess as to why she told you that she attempted suicide.
      She told YOU because she trusted you in some small way, probably just from seeing your face many times and having a pleasant interaction with you.
      She TOLD you because she was desperately reaching out for some affirming attention, for a connection with someone, something to give her an emotional anchor or a psychological point of reference. It doesn’t seem that you recognized her confidentiality and responded to it. So that’s why she had to leave. You were the only thing keeping her there.
      As Scott said, people usually don’t tell others that they want to commit suicide, so the fact that she told you, a mere acquaintance, is an obvious cry for help.
      Again, this is just a guess.

      Liked by 3 people

      • Joe2 says:

        Jack,
        Thanks for your response. The next time I was at the restaurant was a few weeks and since I didn’t see her I asked another waitress about her. She said that she quit because she couldn’t get all the hours / shifts she wanted.

        It’s possible the owner viewed her as a potential liability and just cut back her hours / shifts to minimize the risk and force her out.

        Liked by 2 people

  6. thedeti says:

    Thanks for this, Scott. This is interesting.

    The most interesting part of it to me is that, as a legal practitioner who has worked with mental health professionals in risk management situations, I was under the impression that suicide causes and predictors were much better understood and studied than you tell us here. I thought that psychology and psychiatry much better knew and identified suicide predictors, even understanding that mental health practice is as much art as it is science. The mental health professionals I had dealt with were much more confident and certain about the art and science of suicidology than you intimate is really the case.

    My eyes are opened.

    Liked by 6 people

    • Ed Hurst says:

      Dittos, thedeti. I particularly agree with Scott saying that there’s really not much you can do to stop some near suicide. I have long taken issue with the common panicky reaction folks have to the likelihood of suicide. If you are going to reduce the numbers, you have to stop it long beforehand by creating a frame of reference around yourself that makes suicide mostly pointless. Our culture makes life pointless most of the time, so we have to develop a counterculture of sorts that breaks out of that mold.

      Liked by 3 people

    • Lexet Blog says:

      The legal field has a funny way of interpreting science. For instance, we all know concussions are a thing, and doctors treat concussion patients all the time.

      But it’s nearly impossible to prove that someone had a concussion in a court. It requires “expert witness” testimony, and a thorough diagnosis from your doctor.

      Like

  7. Jack says:

    As a grad student, I knew of two other grad students at my school who killed themselves. One jumped from the 14th floor because he failed his Ph.D. examination and was likely to be booted out of the program. He couldn’t face leaving the U.S. and going back to China in shame. It was sickening to learn that he lived for about two hours before the helpless medics saw him die (their efforts were hopeless due to his condition), and that he left his wife and two children behind. It destroyed student morale so much that a lot of other students resorted to outright denial about what had happened. The other one gave up because his girlfriend started up with another guy, and didn’t finish things up properly with him first. So he was heartbroken when he found out, and he asphyxiated himself by burning charcoal in the bathtub of a hotel room. He was in my research group, but not I nor anyone else had any clue. It fits what Scott said about it being spontaneous and compulsive. It was such a shock that our advisor stopped classes and closed the lab for a week.

    Taiwan has a high rate of suicide, especially among the younger generation. It was very high 10-20 years ago (2-3 cases daily). It was so common that the news wouldn’t report every single case because it was too depressing. The rate seems to have declined a little over the past few years. As a professor, I know there were 1-2 cases of suicide among the student body at my University every year. As soon as I became aware of this, I made a habit of talking about suicide in a jovial manner during the first class session of every course. I would dramatize my expression by pretending to be a whimpering sorrowful student who failed, and then I pretended to leap out the window of the classroom, crying “nooobody loooves meee!” I told students that if they thought they were going to fail my class and wanted to commit suicide, then they should come talk to me first and we would “work out a deal” (joking) so that they wouldn’t forfeit their tuition money after they died. If students asked what the deal was out of curiosity, I would tell them they had to bring a piece of chocolate cake to my office every week. All these words and antics made students laugh, and the levity reduced the tension surrounding the subject which rested in the back of everyone’s minds. So yes, I wholeheartedly agree with Scott that it is helpful to talk about it. Talking about it gets it out on the table where you can see things from another perspective and realize how absurd it is.
    I am thankful to report that none of my own students have committed suicide.

    Liked by 7 people

    • Liz says:

      I agree humor is helpful for switching one’s focus (and just helpful in general, because happiness is something of a habit like most other things).
      But jokes about suicide…as a teacher’s assistant that might lighten the moment, but if someone very close to you is a serious risk it’s kind of hard to joke about.
      I’ve read that about a quarter of kids between 18 and 24 have seriously considered suicide in the past year with the lockdowns, and everything sucking until the end of time by the look of things. As a statistic, if it doesn’t effect your life that just goes into the “hm, that’s interesting” category. When it’s your own kid it’s a little different.

      Liked by 1 person

    • Lexet Blog says:

      People snap in grad school, and it’s not a small number of people. Most don’t resort to suicide though.

      I’ve mentioned my experience with postgrad suicide under other comments, but haven’t discussed how many people I know who were kicked out of universities/arrested for snapping.

      Law schools are toxic environments, as are med schools. I know many prosecutors who were fond of cocaine and illegal prescriptions during law school. I’d say at least 60% of my class was abusing drugs like Ritalin, 70%+ marijuana, 25% cocaine, 40% prescribed antidepressants, and a handful of people who used meth. Everyone turned a blind eye to all of it.

      Like

  8. Ame says:

    Scott – have there been any studies showing chemical level changes that possibly affect those who are suicidal?

    Liked by 1 person

    • Scott says:

      We do know that abrupt changes in serotonin (in either direction I think) and related receptor activity can increase suicide risk.

      If Pukeko (the NZ psychiatrist who runs the blog “dark brightness”) was here he could probably elaborate.

      From the PhD/ non MD perspective I get to assess risk related to those medications that alter such brain activity from a purely algorithmic standpoint. (I just have to know which linear direction the risk goes depending on the drug and the patient variables they tend to interact with) but I’m not qualified to chime in much beyond that.

      The immediate issue that seems understudied to me is the temperament (mostly genetic) one. I keep trying to develop a theory of the mind that introduces this confound, even if only as a weighted risk factor. A placeholder while it is studied more, if you will. No a priori hypothesis about it. But It seems there is a trait that makes it easier for a person to suspend the natural survival instinct that all organisms normally have. This is the instinct that, for example, causes you to jump out of the street if you see a car coming.

      Commuting suicide means you must short circuit that basic instinct.

      Liked by 1 person

  9. Ame says:

    thank you for answering my question.

    But It seems there is a trait that makes it easier for a person to suspend the natural survival instinct that all organisms normally have. This is the instinct that, for example, causes you to jump out of the street if you see a car coming.

    Commuting suicide means you must short circuit that basic instinct.

    this is interesting; haven’t thought of it this way before.

    there is a family member who has had some serious mental health issues this past year, and there have been periods of time the family was deeply concerned he would kill himself. there’s a part of me that is concerned, and there’s another part of me that says i can do what i can do, and then i just have to let it go … because i can’t chase him around hoping to ‘catch’ him before he offs himself, if, indeed, that is his plan. and because i think that he plays mind games with the family as a form of manipulation. and because i think that he’s the type of personality that would do it just to prove he could and to stick it to a certain family member who has caused him an intense amount of grief. he’s also super smart IQ wise, so i never know where his manipulation comes in and when his mental health is legit, if that makes any sense. i try to stay out of it as much as possible; occasionally something happens that requires me to be interactive in his mess on some level.

    on a totally different scale, in a totally different world, my Oldest has been suicidal on two different occasions – both related directly to things her dad did to her. since i’ve stayed very, very close to my daughters, especially through the traumatic years, i was able to draw these things out of her and be a safe place for her to share anything with, so i was able to immediately get her help both times. the initial ‘bad’ thing he did when she was little broke her … like, there’s before and after pics, and she’s a different little girl. recently we were told her serotonin levels might be low, which i think is likely, but i don’t think they were prior to the bad things. i think it was caused by the bad things. she has never used any of this manipulatively, and only because i have intentionally been very close to my daughters would i have ever known because she’s very much an introvert and, due to those things, trusts very few people.

    however, if suicide is an impulsive thing rather than a thought out, premeditated thing, not minimizing things at all for my daughter, but she would be less likely to follow through than someone who is impulsive, because she is definitely not impulsive at all.

    so, i wonder … thinking out loud in all of this … or thinking in type … if impulsive people are more prone to suicide than methodic people? or if the drastic change in serotonin level could cause one to become impulsive.

    Like

    • Scott says:

      however, if suicide is an impulsive thing rather than a thought out, premeditated thing, not minimizing things at all for my daughter, but she would be less likely to follow through than someone who is impulsive, because she is definitely not impulsive at all.

      so, i wonder … thinking out loud in all of this … or thinking in type … if impulsive people are more prone to suicide than methodic people? or if the drastic change in serotonin level could cause one to become impulsive.

      Lack of impulse control, correlated with a number of other factors (like age) is a risk factor for suicide. However, there are also those who, once you conduct the psychological autopsy, leave behind plenty of evidence that they had been planning it for a while.

      I would have to go back to the literature to see what the bright line of distinction between impulsive suicide and longer planned ones. As always its probably a bunch of variables interacting. Age, gender, previous attempts, diagnosis (if known) stuff like that.

      Liked by 1 person

  10. Scott says:

    On a tangential note

    Here’s one thing I have noticed that is almost universally true. Pretty close to 100% of the time, when I hear a complaint about credentialism — the ones who are the loudest, have no credentials. They fire off weird links to articles that supposedly “prove” me wrong or that “this is stuff the medical profession doesn’t want you to know” type conspiracy level stuff. “That doctor they gave me doesn’t know anything about this.”

    This is in some ways understandable, and as for me, as always, I hope to land somewhere in the middle. Always the peacemaker, always the guy in the middle, always the guy trying to help everyone understand each other and love each other through life’s ambiguities.

    I don’t like appealing to credentials or expertise. However, at the same time, I recognize the limitations of both mine, and others in related fields. I know about the left and right limits of what I am qualified and competent to speak on, because I was there. I know what is involved in an MD/DO program with a psychiatry specialty. In the teaching hospital where I did my internship/residency years, I worked right along other specialties in training. Family medicine. Podiatry. You name it. I gained a real appreciation for the immense of training and practice that that was required. Rounding. Presenting case studies. Being constantly evaluated by faculty and critiqued over every little intervention or treatment protocol you try to get right. Its exhausting.

    Where my thing ends and theirs begins is what makes being in these professions so fun.

    I don’t pretend to know everything, and usually they don’t either. Those who are threatened by it appear to expressing more of a internalized disappointment in their own “what I could have done” self let down than anything else. It’s really strange.

    Liked by 1 person

  11. Scott says:

    thank you, Scott.

    I feel like maybe I could have responded with a little more empathy, so let me try. If this sounds condescending at all, please forgive me. I never mean that.

    Think of doctors like gamblers. It doesn’t matter what their specialty is. Even in a “well check” your primary care doc is assessing risk (for all kinds of things). They use all the tools they have at their disposal for that, and they also add clinical judgment, which is a fancy way of saying expertise/experience

    For example, way back in 2010, I was about to deploy and I started having atypical chest pain on exertion (on my runs). At the time, I was a little bit heavier than I usually am (not obese, just about 10lbs over where I like to be). I was in a simple yearly check up and I mentioned it to my doctor (a cardiac resident who was rotating through primary care). After she took the entire H&P, she gathered more data, because her handy physicians desk reference was telling her there was an elevated risk. That risk was for an imminent heart attack, and it was based on my description of the pain, plus height, weight, age, girth of my belly, blood pressure, and whole bunch of other things. As I heard her walking down the hallway with her supervisor in tow, I overheard him say “according to the algorithm, we should admit him over night to observe.” He spent a few more minutes with me, and decided against it but a full work up including stress test with contrast die, ECG, etc was ordered. In the end, it was probably just anxiety over the upcoming deployment. My heart was fine.

    He gambled that he could let me leave that day and come back for an outpatient work up, and won.

    Likewise, for my specialty, (and psychiatry) suicide is dead center in my scope of practice wheelhouse. So, every patient I see is being evaluated for that particular risk. And every time I let them walk out the door without admitting them to the hospital, I am betting on them living (not committing suicide). I hate how cold and calculating that sounds, but that is how it works.

    Understandably, you would like a doctor to say “oh, your daughter isn’t impulsive, you’re good to go.” And there are a number of reasons you wont hear this. The first is, I have not personally evaluated her. However, I can tell you this. Since suicide is such a low base rate phenomenon, the mental health provider, if he was a gambling man will always bet on what he perceives is the winning horse. The winning horse is almost always they will live. This is very long winded way of saying “most people do not kill themselves. So all things being equal, I will bet on that horse.”

    The problem is one of testing power, in particular the dual mathematical problems of sensitivity versus specificity. If the provider could have every piece of information available on a given patient, and a test was developed with a sufficient amount of sensitivity (the ability to detect something) with the current state of the art as it stands today, that test would not have enough specificity (the ability to distinguish between one thing and another ). This would create a situation where way too many people would be admitted to the hospital. This is because the test would detect something in way too many people, (false positives) most of whom would not actually be at high enough (imminent) risk.

    And so, the doctor relies on clinical judgment and bets on “will live” as a default.

    Reading back through that it sounds even less empathic. Sorry.

    Liked by 1 person

    • Ame says:

      Scott, I did not see any lack of empathy in any of your responses, but thank you for caring enough.

      I’m no longer concerned about my daughter for several reasons.
      1. The most important reason is that she always feels safe telling me how she’s really doing, and she is open and receptive to me asking her the hard questions.

      As cold as this sounds, her daddy is dead now almost 7 years. Those who knew what was going on and who were praying for us, people who didn’t know each other, and people who have heard the story since, have all said that God said enough and his time was up. Interestingly, both my daughters came to this same conclusion on their own as they worked through their grief.
      She has forgiven her Dad (both my girls have), and we talk about him often, pretty much daily. I made them face the truth of who he was – the good and the bad, and they are at peace with that.
      She willingly goes to therapy when she needs it. She has always responded very well to counseling.
      She knows I’ll do everything I possibly can to help her and that I’m always on her side and always have her back.
      She knows it would hurt me, and both my girls are fiercely protective of me and love me fiercely. And she doesn’t want to hurt me.
      Her sister, my Aspie Girl, needs her

      She is also very open about all this. When their Dad left us I decided no more lies. Telling the truth and facing our own truths has been expected. I’ve taught my girls we all have something. Own your own something and deal with it and move on because this life is (1) not all about you, and (2) not fair, just, or equal. And, most importantly, God is good, He loves us, He will never leave nor forsake us, and He will use everything for our good and His glory in His time and in His ways.

      Like

      • Ame says:

        Well, boo, I had numbered all those but they were dropped. I’m sure I missed something using my phone 😀

        Like

  12. SFC Ton says:

    Thank you Scott

    I have had way to many friends check out like that. It’s something I think the military ( & society at large) supports despite its lip service. I’m more surprised so many men don’t take folks with them vs suicide in general.

    Liked by 3 people

    • cameron232 says:

      “I’m more surprised so many men don’t take folks with them vs suicide in general.”

      I have the same thought all the time. Particularly the men we now see being tormented/attacked/prosecuted by the Left. No I’m not advocating it – I’m just surprised – you’re gonna die anyway – you let them win?

      Liked by 1 person

      • Oscar says:

        Give it time, brother. Give it time.

        Liked by 2 people

      • Lexet Blog says:

        I know a wheelchair bound man (very old, not sure if he is still kicking) who once told me that if he was ever diagnosed with cancer, he’d turn himself into an IED to take out certain people in a certain political organization.

        He was a former cia officer. Wikipedia has a page on him. I say no more

        Liked by 1 person

      • SFC Ton says:

        Only thing I’ve come up with is way to many don’t yet understand that the shit storms of their life were engineered by certain people’s belief systems and actions

        But I reckon that will change some when more men realize life is a 0 sum game

        Liked by 1 person

  13. lastmod says:

    There is no “mechanism” for most men to get treatment. There is a terrible stigma. It’s on file “somewhere” if you get or need help. In the past the church could maybe help. Maybe some civic organization where one could be useful (Elks Club for example). Even volunteering with the Salvation Army requires a boatload of paperwork to process you as a volunteer….bacvkground checks….oh, you had some “mental illness” or a “5150” comes up??????? They and a billion other organizations don’t need “your help”

    Men need friends. Who has friends today? I certainly don’t. I know a few people…but no one I could ever talk to about serious stuff. Tell some men in a “mens group” about some real serious thing you may indeed be going through. These jerks will tell their wives….and you know, the whole church will know.

    Most advice is “be a man” and “deal with it” and then they deal with it and then everyone is wondering why “men don’t get help”

    And….according to the sphere and related travelers……men who need help are “losers” anyway. So what’s the point.

    As for the military. If a man is Vet he has a sh*t ton of services availible. If I DARE forget to ask a potential applicant I am going to hire his Veteran status, the American Legion, the VA and countless other advocacy will be painting me as a man who “hates” veterans because I didn’t ask, and offer them a gazillion other benefits they get for being a veteran at my organization……or I have to “move” said veteran to the top of the list as a potential hire because “he / she put his / her ass on the line for me” (as if)

    Suicide is a very serious thing, and the reason why they are so tragic is because we live a culture that is reactive now. Like the police……they don’t police. They come and clean up the mess AFTER crime, murder and death happen. We also live a blame culture. The person who indeed takes their own life. That is on them. No one made them do it. The pain they are suffering is that great…..but family and so-called friends after it happens want someone or anyone to blame.

    Maybe they should have called

    After Kurt Cobain offed himself back in 1994…..every musician was suddenly saying “We talked a few months ago…we were planning to record some stuff together”

    From REM, to every group in Seattle at the time, the whole US and UK ‘alternative’ scene. Maybe these poseurs should have called. Dropped in.

    Anything to make suicide “so tragic” but in a world where most men have no friends……maybe that’s where we should start.

    The friendless I am sure “deserved” it somehow……..its also kind of hard to make friends when the sex-act, how many women like you, liked you, and how many would like you if you were not married is really hard to compete against when you’re batting .600 in life.

    Covid is a problem too…….and most men are worse than women when it comes to sh*tting on each other if truth be told

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s